Healthcare Provider Details

I. General information

NPI: 1255800066
Provider Name (Legal Business Name): ROBERTA R. GELFAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBERTA REIS MOREIRA

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 03/19/2022
Certification Date: 03/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W 17TH ST
NEW YORK NY
10011-5325
US

IV. Provider business mailing address

PO BOX 462
FAIR LAWN NJ
07410-0462
US

V. Phone/Fax

Practice location:
  • Phone: 212-206-5200
  • Fax:
Mailing address:
  • Phone: 646-883-4767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number105612
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06057500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: