Provider Demographics
NPI:1306148754
Name:POPELKA, GAYLE MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:MARIE
Last Name:POPELKA
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 1:4425 MILITARY TRAIL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-747-2775
Mailing Address - Fax:
Practice Address - Street 1:4425 MILITARY TRL
Practice Address - Street 2:SUITE 203
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4819
Practice Address - Country:US
Practice Address - Phone:561-747-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 55751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical