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NPI Code Detail

MEDICARE: MRS. DEIRDRE DENISE GAMBLE LMSW

MEDICARE: MRS. DEIRDRE DENISE GAMBLE LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801071005MI

General Provider Information

NPI Number : 1376667584
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEIRDRE DENISE GAMBLE LMSW
Provider Business Mailing Address
First Line : 13535 APPLETON ST
Second Line :
City : DETROIT
State : MI
Zip : 48223-3029
Country : US
Telephone Number : 313-255-8887
Fax Number :
Provider Business Practice Location Address
First Line : 3737 LAWTON ST
Second Line :
City : DETROIT
State : MI
Zip : 48208-2500
Country : US
Telephone Number : 313-361-6136
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/08/2007

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