Healthcare Provider Details

I. General information

NPI: 1750109237
Provider Name (Legal Business Name): JULIE GILGORE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

2190 BOSTON RD APT 2L
BRONX NY
10462-1247
US

V. Phone/Fax

Practice location:
  • Phone: 718-975-6330
  • Fax:
Mailing address:
  • Phone: 856-534-9975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088604
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: