George Gamon, CPSW

Individual provider Active NPI Peer Specialist · Anthony, NM

NPI 1417591116 · NPPES record last updated Feb 12, 2021

Key facts

NPI: 1417591116
Entity type: Individual (NPI type 1)
Primary specialty: Peer Specialist 175T00000X
License: 1011 (NM)
Practice address: 224 Anthony Dr Ste B
Anthony, NM 88021-9366
Phone: (585) 619-0485
NPI assigned: Nov 5, 2019
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
1011	NM	MD	Clinical Psychologist

Interoperability endpoints

Direct secure messaging: www.nmpsychiatrics&ass@mail.com

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Behavior Technician	106S00000X
Peer Specialist	175T00000X	1011	NM	Yes

Addresses

Primary practice location

224 Anthony Dr Ste B
Anthony, NM 88021-9366

Mailing address

PO Box 584
Chamberino, NM 88027-0584
Phone (575) 619-0485

Other practice location 1

27777 Inkster Rd Ste 100
Farmington Hills, MI 48334-5312
Phone (248) 299-0030

Electronic endpoints

Type	Endpoint	Use	Affiliation
Direct Messaging Address	Www.nmpsychiatrics&ass@mail.com	Direct

Other providers in Anthony, NM

All providers in Anthony, NM · Peer Specialist in New Mexico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.