=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093918443
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTHA GUNZBURG LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 W 96TH ST 1A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025-6540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-864-3924
-----------------------------------------------------
Fax | 212-722-0727
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 W 96TH ST 1A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025-6540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-864-3924
-----------------------------------------------------
Fax | 212-722-0727
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 102L00000X
-----------------------------------------------------
Taxonomy Name | Psychoanalyst
-----------------------------------------------------
License Number | 19 000441
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R007699
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------