Provider Demographics
NPI:1952846859
Name:GRETCHEN WHITE LCSW, LLC
Entity Type:Organization
Organization Name:GRETCHEN WHITE LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD, LLC
Authorized Official - Phone:860-435-1411
Mailing Address - Street 1:759 PINE RUN DR
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9544
Mailing Address - Country:US
Mailing Address - Phone:860-435-1411
Mailing Address - Fax:850-926-7500
Practice Address - Street 1:928 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9218
Practice Address - Country:US
Practice Address - Phone:860-435-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW11113251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health