MEDICARE: MR. ROBERT GORLACH LCSW

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	C005841	NC
2	1041C0700X	Clinical Social Worker	052205	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	147EF	OTHER		BCBSNC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598824021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT GORLACH LCSW

Provider Business Mailing Address
First Line	:	PO BOX 538622
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-8622
Country	:	US
Telephone Number	:	910-742-9243
Fax Number	:	888-746-1787

Provider Business Practice Location Address
First Line	:	1213 CULBRETH DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-3639
Country	:	US
Telephone Number	:	910-742-9243
Fax Number	:	888-746-1787

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	04/14/2015

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