1982692877 NPI number — ANN GABOR LCSW

Table of content: ANN GABOR LCSW (NPI 1982692877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982692877 NPI number — ANN GABOR LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GABOR
Provider First Name:
ANN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982692877
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/20/2017
NPI Reactivation Date:
09/15/2017

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1312 OLD VILLAGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32312-3919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-894-6626
Provider Business Mailing Address Fax Number:
850-765-8329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1615 VILLAGE SQUARE BLVD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-894-6626
Provider Business Practice Location Address Fax Number:
850-765-8329
Provider Enumeration Date:
10/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW5247 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 323030000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: BLUE CROSS/BLUE SHIE . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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