Individual
GEORGE GAMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPSW
Contact information
Practice address
224 ANTHONY DR STE B, ANTHONY, NM 88021-9366
(585) 619-0485
Mailing address
PO BOX 584, CHAMBERINO, NM 88027-0584
(575) 619-0485
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
175T00000X
Peer Specialist
Primary
1011
NM
Other
Enumeration date
11/05/2019
Last updated
02/12/2021
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