Provider Demographics
NPI:1528000262
Name:GASKELL, VIRGINIA LEWIS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:LEWIS
Last Name:GASKELL
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 1:12168 SAGE AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-9033
Mailing Address - Country:US
Mailing Address - Phone:850-255-0437
Mailing Address - Fax:
Practice Address - Street 1:3300 N PACE BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-5148
Practice Address - Country:US
Practice Address - Phone:850-434-6774
Practice Address - Fax:850-434-6784
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00020681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5654OtherPREVIOUS BC/BS
Z5654Medicare ID - Type UnspecifiedPREVIOUS