Healthcare Provider Details

I. General information

NPI: 1588066450
Provider Name (Legal Business Name): MYRIAM EDITH GEHY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24005 144TH AVE
ROSEDALE NY
11422-2301
US

IV. Provider business mailing address

24005 144TH AVE
ROSEDALE NY
11422-2301
US

V. Phone/Fax

Practice location:
  • Phone: 917-541-9059
  • Fax:
Mailing address:
  • Phone: 917-541-9059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number072380-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: