Healthcare Provider Details

I. General information

NPI: 1487297669
Provider Name (Legal Business Name): GWENN KUDLER GELFAND LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 COMMUNITY DR STE 206
MANHASSET NY
11030-3820
US

IV. Provider business mailing address

420 E 61ST ST APT 15E
NEW YORK NY
10065-8773
US

V. Phone/Fax

Practice location:
  • Phone: 516-702-2185
  • Fax:
Mailing address:
  • Phone: 516-702-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR34018
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: