Healthcare Provider Details

I. General information

NPI: 1073852588
Provider Name (Legal Business Name): CLARE LESLIE GEBEY LSW, LCSW-NY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLARE LESLIE LAROSA LSW, LCSW-NY

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 BROADWAY KIDSPEACE, CAPTAIN WILEY BUILDING, 2ND FLOOR
BETHLEHEM PA
18015-3904
US

IV. Provider business mailing address

1650 BROADWAY KIDSPEACE, CAPTAIN WILEY BUILDING, 2ND FLOOR
BETHLEHEM PA
18015-3904
US

V. Phone/Fax

Practice location:
  • Phone: 610-799-7343
  • Fax: 610-799-8230
Mailing address:
  • Phone: 610-799-7343
  • Fax: 610-799-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0727981
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberSW012011L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: