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NPI Code Detail

MEDICARE: WAYNE GURNICK LCSW

MEDICARE: WAYNE GURNICK 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
11041C0700XClinical Social Worker050891-1NY

General Provider Information

NPI Number : 1760621395
Entity Type Code : Individual
Provider Name (Legal Business Name) : WAYNE GURNICK LCSW
Provider Business Mailing Address
First Line : 3600 ROUTE 112
Second Line :
City : CORAM
State : NY
Zip : 11727-4116
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3600 ROUTE 112
Second Line :
City : CORAM
State : NY
Zip : 11727-4116
Country : US
Telephone Number : 631-920-8302
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2009
Last Update Date : 02/04/2009

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Directions to “ WAYNE GURNICK LCSW” Practice Location

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