Provider Demographics
NPI:1659324986
Name:GERRICK, ROBERT HOWARD (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:HOWARD
Last Name:GERRICK
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17155 KNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-2616
Mailing Address - Country:US
Mailing Address - Phone:239-433-1745
Mailing Address - Fax:
Practice Address - Street 1:10501 FGCU BLVD S
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33965-6502
Practice Address - Country:US
Practice Address - Phone:239-590-7950
Practice Address - Fax:239-590-7968
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8646101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health