Provider Demographics
NPI:1184630055
Name:GAMBLE, VERONICA LYNN (LICSW)
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:LYNN
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 E HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1518
Mailing Address - Country:US
Mailing Address - Phone:973-954-7197
Mailing Address - Fax:
Practice Address - Street 1:600 SUPERIOR AVE E STE 1300
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2654
Practice Address - Country:US
Practice Address - Phone:973-954-7197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0005618-SUPV1041C0700X
OH1001761041C0700X
RIIWS016431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical