Provider Demographics
NPI:1033638226
Name:GOREY, MARK P (LSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:GOREY
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 TREMAINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4039
Mailing Address - Country:US
Mailing Address - Phone:419-214-0606
Mailing Address - Fax:
Practice Address - Street 1:1776 TREMAINSVILLE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4039
Practice Address - Country:US
Practice Address - Phone:419-214-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.10008511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical