| Doctor Name: | MR. GARY L SHORT |
| NPI Number: | 1164674677 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW-R |
| License Number: | R02539-1 |
| Business Practice Address: | 7634 Campbell Creek Rd Family Life Ministries Bath, NY - 148107612 |
| Business Phone Number: | 6077764151 |
| Business Fax Number: | 6077766929 |
| Mailing Address: | 7815 County Route 13, BATH |
| State: | NY |
| Postal Code: | 148107904 |
| Phone Number: | 6077764151 |
| Fax Number: | 6077766929 |
| NPI Enumeration Date: | 10/15/2008 |
| NPI Last Update Date: | 10/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | R02539-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |