Healthcare Provider Details

I. General information

NPI: 1629211578
Provider Name (Legal Business Name): NELIMA W GAONKAR LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S ALBANY ST
ITHACA NY
14850-5446
US

IV. Provider business mailing address

PO BOX 475
ITHACA NY
14851-0475
US

V. Phone/Fax

Practice location:
  • Phone: 315-254-6870
  • Fax:
Mailing address:
  • Phone: 607-729-6206
  • Fax: 607-729-6206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number078394-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: