Provider Demographics
NPI:1124267026
Name:GATENS, MARY CHRISTINE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:GATENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 LAKEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-6727
Mailing Address - Country:US
Mailing Address - Phone:919-491-2763
Mailing Address - Fax:
Practice Address - Street 1:2108 LAKEVILLE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917
Practice Address - Country:US
Practice Address - Phone:919-491-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist