Provider Demographics
NPI:1750052759
Name:GOURLEY, CRAIG (MSW , LSW)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:GOURLEY
Suffix:
Gender:M
Credentials:MSW , LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7052 ROUTE 6N
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-9610
Mailing Address - Country:US
Mailing Address - Phone:814-734-3975
Mailing Address - Fax:814-734-1265
Practice Address - Street 1:7052 ROUTE 6N
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-9610
Practice Address - Country:US
Practice Address - Phone:814-734-3975
Practice Address - Fax:814-734-1265
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135039104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty