Provider Demographics
NPI:1073068276
Name:HINEBAUGH, GAYLE C (LCSW)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:C
Last Name:HINEBAUGH
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 1:119 AUGUSTINE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-5438
Mailing Address - Country:US
Mailing Address - Phone:814-442-2150
Mailing Address - Fax:814-217-1766
Practice Address - Street 1:520 HUGART ST
Practice Address - Street 2:
Practice Address - City:CONFLUENCE
Practice Address - State:PA
Practice Address - Zip Code:15424-1018
Practice Address - Country:US
Practice Address - Phone:814-714-0001
Practice Address - Fax:814-217-1766
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0178771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA542528Medicare PIN