Provider Demographics
NPI:1427487032
Name:GERBER, MARY MEADERS (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MEADERS
Last Name:GERBER
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 1:407 ALDO DR
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-4995
Mailing Address - Country:US
Mailing Address - Phone:386-503-1779
Mailing Address - Fax:
Practice Address - Street 1:50 LEANNI WAY
Practice Address - Street 2:SUITE B3
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4751
Practice Address - Country:US
Practice Address - Phone:386-446-5494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW114121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical