Provider Demographics
NPI:1700847159
Name:VAN ARMAN, GARY
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:VAN ARMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4090 12TH PL SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-4837
Mailing Address - Country:US
Mailing Address - Phone:772-569-8908
Mailing Address - Fax:
Practice Address - Street 1:1405 21ST ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3490
Practice Address - Country:US
Practice Address - Phone:772-569-8908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW168001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2511OtherBLUECROSS
FLZ2511OtherBLUECROSS