Provider Demographics
NPI:1982692877
Name:GABOR, ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:GABOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 OLD VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-3919
Mailing Address - Country:US
Mailing Address - Phone:850-894-6626
Mailing Address - Fax:850-765-8329
Practice Address - Street 1:1615 VILLAGE SQUARE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309
Practice Address - Country:US
Practice Address - Phone:850-894-6626
Practice Address - Fax:850-765-8329
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2017-09-15
Deactivation Date:2017-01-20
Deactivation Code:
Reactivation Date:2017-09-15
Provider Licenses
StateLicense IDTaxonomies
FLSW52471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL323030000Medicaid
FLBLUE CROSS/BLUE SHIEOtherBCBS PROVIDER NUMBER
FLZ8743Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER