Basic Information
Provider Information | |||||||||
NPI: | 1306148754 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | POPELKA | ||||||||
FirstName: | GAYLE | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | L.C.S.W. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4425 MILITARY TRAIL | ||||||||
Address2: | SUITE 203 | ||||||||
City: | JUPITER | ||||||||
State: | FL | ||||||||
PostalCode: | 33458 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5617472775 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4425 MILITARY TRL | ||||||||
Address2: | SUITE 203 | ||||||||
City: | JUPITER | ||||||||
State: | FL | ||||||||
PostalCode: | 334584819 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5617472775 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/17/2010 | ||||||||
LastUpdateDate: | 01/26/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW 5575 | FL | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.