MEDICARE: LAURIE D GILKES LCSW PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	PR012668-1	NY

General Provider Information

NPI Number	:	1003092958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURIE D GILKES LCSW PC

Provider Business Mailing Address
First Line	:	330 E 79TH ST
Second Line	:	SUITE 1G
City	:	NEW YORK
State	:	NY
Zip	:	10075-0966
Country	:	US
Telephone Number	:	212-737-0560
Fax Number	:	212-737-0560

Provider Business Practice Location Address
First Line	:	330 E 79TH ST
Second Line	:	SUITE 1G
City	:	NEW YORK
State	:	NY
Zip	:	10075-0966
Country	:	US
Telephone Number	:	212-737-0560
Fax Number	:	212-737-0560

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. LAURIE D GILKES
Credential	:	LCSW PC
Telephone Number	:	212-737-0560

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	05/07/2009

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