Provider Demographics
NPI:1194238683
Name:GAMMINO, MICHAEL E (CLINCIAL SOCIAL WORK)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:GAMMINO
Suffix:
Gender:M
Credentials:CLINCIAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 475485
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94147-5485
Mailing Address - Country:US
Mailing Address - Phone:415-931-2684
Mailing Address - Fax:
Practice Address - Street 1:3610 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1734
Practice Address - Country:US
Practice Address - Phone:415-931-2684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA162841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14127040OtherCAQH ID