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General NPI Number Information
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NPI Number | 1013217587
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Entity Type | Individual
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Provider Name | GLADSTONE NATHANIEL MARSHALL LMSW
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Gender | Male
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 10/29/2010
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Provider Practice Location Address
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Address Line | 621 ELMONT RD
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City | ELMONT
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State | NY
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Zip | 11003-4028
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Country | US
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Telephone | 516-616-0580
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Fax | 516-616-0582
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Provider Business Mailing Address
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Address Line | 621 ELMONT RD
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City | ELMONT
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State | NY
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Zip | 11003-4028
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Country | US
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Telephone | 516-616-0580
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Fax | 516-616-0582
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 029573-1
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License Number State | NY
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