MEDICARE: MRS. MARGARET A GUMMOE 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	103T00000X	Psychologist	SW0001714	FL

General Provider Information

NPI Number	:	1801903877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARGARET A GUMMOE LCSW

Provider Business Mailing Address
First Line	:	16554 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1325
Country	:	US
Telephone Number	:	813-968-7188
Fax Number	:	813-968-7627

Provider Business Practice Location Address
First Line	:	16554 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1325
Country	:	US
Telephone Number	:	813-968-7188
Fax Number	:	813-968-7627

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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