Doctor Name: | DR. GRETCHEN ANN MIMS |
NPI Number: | 1639455348 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMSW, PH.D |
License Number: | 072120-1 |
Business Practice Address: | 81 Bolton Trl North Chili, NY - 145149774 |
Business Phone Number: | 5858896429 |
Business Fax Number: | |
Mailing Address: | 81 Bolton Trl, NORTH CHILI |
State: | NY |
Postal Code: | 145149774 |
Phone Number: | 5858896429 |
Fax Number: | |
NPI Enumeration Date: | 10/26/2011 |
NPI Last Update Date: | 10/26/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041S0200X |
License Number: | 072120-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | School |
Taxonomy Definition: |