Healthcare Provider Details

I. General information

NPI: 1447697040
Provider Name (Legal Business Name): RORY KEITH GILBERT LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 W 108TH ST
NEW YORK NY
10025-2956
US

IV. Provider business mailing address

14 E 126TH ST PRIVATE HOUSE
NEW YORK NY
10035-1525
US

V. Phone/Fax

Practice location:
  • Phone: 212-663-3000
  • Fax:
Mailing address:
  • Phone: 212-289-1788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number072515
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: