MEDICARE: GAIL DOBISH

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
1	1041C0700X	Clinical Social Worker	X-06094	NM
2	1041C0700X	Clinical Social Worker	071229	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X-06094	OTHER	NM	LISW
2	071229	OTHER	NY	LCSW

General Provider Information

NPI Number	:	1437335437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL DOBISH

Provider Business Mailing Address
First Line	:	2960 RODEO PARK DR W
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-6353
Country	:	US
Telephone Number	:	505-986-9633
Fax Number	:

Provider Business Practice Location Address
First Line	:	2960 RODEO PARK DR W
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-6353
Country	:	US
Telephone Number	:	505-986-9633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	01/21/2008

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Directions to “ GAIL DOBISH ” Practice Location

Language	Start Address	Practice Location

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