Healthcare Provider Details

I. General information

NPI: 1295426302
Provider Name (Legal Business Name): JESSICA GELFAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 LAWRENCE ST FL 4
BROOKLYN NY
11201-5240
US

IV. Provider business mailing address

1298 DEKALB AVE APT 2
BROOKLYN NY
11221-3235
US

V. Phone/Fax

Practice location:
  • Phone: 347-491-0296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number095298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: