Provider Demographics
NPI:1437712312
Name:JUDY L. GUNN LCSW, P.A.
Entity Type:Organization
Organization Name:JUDY L. GUNN LCSW, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-430-1090
Mailing Address - Street 1:111 N POMPANO BEACH BLVD APT 511
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5742
Mailing Address - Country:US
Mailing Address - Phone:248-219-3624
Mailing Address - Fax:
Practice Address - Street 1:2003 W CYPRESS CREEK RD STE 109
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1834
Practice Address - Country:US
Practice Address - Phone:248-219-3624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty