Provider Demographics
NPI:1295037901
Name:FULL CIRCLE WOMENS HEALTH
Entity Type:Organization
Organization Name:FULL CIRCLE WOMENS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSSACK
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:914-421-1500
Mailing Address - Street 1:1241 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5201
Mailing Address - Country:US
Mailing Address - Phone:914-421-1500
Mailing Address - Fax:914-421-1501
Practice Address - Street 1:1241 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-5201
Practice Address - Country:US
Practice Address - Phone:914-421-1500
Practice Address - Fax:914-421-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000334176B00000X
NYF000403176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty