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NPI Code Detail

MEDICARE: JAYCIE MARIE GAUCI LMSW

MEDICARE: JAYCIE MARIE GAUCI 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 Worker6801103858MI
21041C0700XClinical Social Worker6801112447MI

General Provider Information

NPI Number : 1477175420
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAYCIE MARIE GAUCI LMSW
Provider Business Mailing Address
First Line : 24119 THORN DR
Second Line :
City : BROWNSTOWN
State : MI
Zip : 48134-6037
Country : US
Telephone Number : 734-751-7296
Fax Number :
Provider Business Practice Location Address
First Line : 23100 JEFFERSON AVE
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48080-2756
Country : US
Telephone Number : 734-304-4159
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2020
Last Update Date : 10/05/2023

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