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NPI Code Detail

MEDICARE: MATTHEW THOMAS GILMOUR LCSW

MEDICARE: MATTHEW THOMAS GILMOUR 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 WorkerSW11653FL

General Provider Information

NPI Number : 1801280300
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW THOMAS GILMOUR LCSW
Provider Business Mailing Address
First Line : 311 N ORANGE ST
Second Line :
City : NEW SMYRNA BEACH
State : FL
Zip : 32168-6733
Country : US
Telephone Number : 386-254-1283
Fax Number : 386-254-1130
Provider Business Practice Location Address
First Line : 311 N ORANGE ST
Second Line :
City : NEW SMYRNA BEACH
State : FL
Zip : 32168-6733
Country : US
Telephone Number : 386-254-1283
Fax Number : 386-254-1130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2015
Last Update Date : 03/23/2015

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