Provider Demographics
NPI:1366584823
Name:WHITE, GALE MARIE (MSW/MA)
Entity type:Individual
Prefix:MS
First Name:GALE
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSW/MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 S DORSEY LN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3911
Mailing Address - Country:US
Mailing Address - Phone:269-930-1607
Mailing Address - Fax:
Practice Address - Street 1:6410 S DORSEY LN
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3911
Practice Address - Country:US
Practice Address - Phone:269-930-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2016-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801078413104100000X
AZLCSW-155171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN30810013Medicare PIN