Provider Demographics
NPI:1972644581
Name:NORMAN, GARY LEE (LICSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:NORMAN
Suffix:
Gender:M
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14323 GOLF VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-3004
Mailing Address - Country:US
Mailing Address - Phone:612-816-8434
Mailing Address - Fax:
Practice Address - Street 1:15-2660 PAHOA VILLAGE RD STE 203-521
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-6720
Practice Address - Country:US
Practice Address - Phone:612-816-8434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN186261041C0700X
HILCSW-48421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical