MEDICARE: JUDY L. GUNN LCSW, P.A.

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

General Provider Information

NPI Number	:	1437712312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDY L. GUNN LCSW, P.A.

Provider Business Mailing Address
First Line	:	111 N POMPANO BEACH BLVD APT 511
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-5742
Country	:	US
Telephone Number	:	248-219-3624
Fax Number	:

Provider Business Practice Location Address
First Line	:	2003 W CYPRESS CREEK RD STE 109
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1834
Country	:	US
Telephone Number	:	248-219-3624
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	PATTY GEORGE
Credential	:
Telephone Number	:	321-430-1090

Provider Enumeration Date	:	04/17/2019
Last Update Date	:	04/17/2019

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