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NPI Code Detail

MEDICARE: MR. GREGORY J DE POL L.M.H.C.

MEDICARE: MR. GREGORY J DE POL L.M.H.C.
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
1101YM0800XMental Health CounselorMH9535FL
2101YP2500XProfessional Counselor37PC00313700NJ

General Provider Information

NPI Number : 1518992734
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GREGORY J DE POL L.M.H.C.
Provider Business Mailing Address
First Line : 4426 KENTUCKY WAY
Second Line :
City : AVE MARIA
State : FL
Zip : 34142-5016
Country : US
Telephone Number : 551-427-9756
Fax Number :
Provider Business Practice Location Address
First Line : 6075 BATHEY LN
Second Line :
City : NAPLES
State : FL
Zip : 34116-7536
Country : US
Telephone Number : 239-455-8500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 02/22/2010

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