Basic Information
| Provider Information | |||||||||
| NPI: | 1013221175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORKMAN | ||||||||
| FirstName: | GLORIA | ||||||||
| MiddleName: | MARTA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 690 BARNES BLVD | ||||||||
| Address2: | |||||||||
| City: | JOINT BASE LEWIS MCCHORD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984381303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539823685 | ||||||||
| FaxNumber: | 2539829037 | ||||||||
| Practice Location | |||||||||
| Address1: | 690 BARNES BLVD | ||||||||
| Address2: | |||||||||
| City: | JOINT BASE LEWIS MCCHORD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984381303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539823685 | ||||||||
| FaxNumber: | 2539829037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2010 | ||||||||
| LastUpdateDate: | 08/06/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 071005035 | IL | Y | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 2362 | TN | N | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.