Provider Demographics
NPI:1225214950
Name:GINGELL, MADOLYN BIERY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MADOLYN
Middle Name:BIERY
Last Name:GINGELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 PRATHER DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3126
Mailing Address - Country:US
Mailing Address - Phone:239-415-9868
Mailing Address - Fax:239-415-9868
Practice Address - Street 1:338 PRATHER DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3126
Practice Address - Country:US
Practice Address - Phone:239-415-9868
Practice Address - Fax:239-415-9868
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW-73481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical