MEDICARE: KRISTINE NICKEL NICKEL GAYLE 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	CSW004733	GA

General Provider Information

NPI Number	:	1952468332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE NICKEL NICKEL GAYLE LCSW

Provider Business Mailing Address
First Line	:	635 STEPHENSON AVE
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-5970
Country	:	US
Telephone Number	:	912-352-2921
Fax Number	:	912-352-1038

Provider Business Practice Location Address
First Line	:	635 STEPHENSON AVE
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-5970
Country	:	US
Telephone Number	:	912-352-2921
Fax Number	:	912-352-1038

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	12/18/2025

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