MEDICARE: MS. MARY H GAY L.C.S.W.

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	0904002070	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003755	OTHER	VA	VALUE OPTIONS
2	132215	OTHER	VA	MHN
3	3080747	OTHER	VA	BCBS
4	O85422	OTHER	VA	OPTIMA/SENTARA
5	137760	OTHER	VA	COMPSYCH
6	132215	OTHER	VA	TRICARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	208793000	OTHER	VA	MAGELLAN

General Provider Information

NPI Number	:	1497754113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY H GAY L.C.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 35395
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-0395
Country	:	US
Telephone Number	:	804-378-3364
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 POTTERS RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4322
Country	:	US
Telephone Number	:	757-456-1697
Fax Number	:

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	11/25/2009

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