MEDICARE: MRS. GAIL HELENE KORRICK MSSS / 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	000038	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	140000038CT-01	OTHER	CT	ANTHEM BC/BS
2	004178259-00	OTHER	CT	ANTHEM BC/BS

General Provider Information

NPI Number	:	1811992431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GAIL HELENE KORRICK MSSS / LCSW

Provider Business Mailing Address
First Line	:	111 PARK ST
Second Line	:	STE 1L
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-5472
Country	:	US
Telephone Number	:	203-776-8673
Fax Number	:	203-787-6677

Provider Business Practice Location Address
First Line	:	111 PARK ST
Second Line	:	STE 1L
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-5472
Country	:	US
Telephone Number	:	203-776-8673
Fax Number	:	203-787-6677

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/08/2007

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