Provider Demographics
NPI:1982244331
Name:GANS, MICHAEL MOSES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MOSES
Last Name:GANS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 NE 20TH STREET
Mailing Address - Street 2:#603
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305
Mailing Address - Country:US
Mailing Address - Phone:561-578-9348
Mailing Address - Fax:866-757-5778
Practice Address - Street 1:520 NE 20TH STREET
Practice Address - Street 2:#603
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305
Practice Address - Country:US
Practice Address - Phone:561-578-9348
Practice Address - Fax:866-757-5778
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW169061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical