MEDICARE: CHERYL M GULLY 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	16756	CA

General Provider Information

NPI Number	:	1962632299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL M GULLY LCSW

Provider Business Mailing Address
First Line	:	1135 S HIGHLAND AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-1751
Country	:	US
Telephone Number	:	323-509-9531
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 S HIGHLAND AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-1751
Country	:	US
Telephone Number	:	323-509-9531
Fax Number	:

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

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	10/16/2024

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