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NPI Code Detail

MEDICARE: GISELLE G GAVILANES LCSW

MEDICARE: GISELLE G GAVILANES LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker074044NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912017344
Entity Type Code : Individual
Provider Name (Legal Business Name) : GISELLE G GAVILANES LCSW
Provider Business Mailing Address
First Line : 8717 21ST AVE
Second Line : APT. 2A
City : BROOKLYN
State : NY
Zip : 11214-4951
Country : US
Telephone Number : 917-593-2155
Fax Number :
Provider Business Practice Location Address
First Line : 57 SAINT MARKS PL
Second Line :
City : NEW YORK
State : NY
Zip : 10003-7902
Country : US
Telephone Number : 212-982-3470
Fax Number : 212-477-0521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/08/2007

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