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NPI Code Detail

MEDICARE: GERARDA MCDOUGALL LCSW

MEDICARE: GERARDA MCDOUGALL LCSW
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
11041C0700XClinical Social WorkerR046340-1NY
21041C0700XClinical Social WorkerR-046340-1NY

General Provider Information

NPI Number : 1053425702
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERARDA MCDOUGALL LCSW
Provider Business Mailing Address
First Line : 366 N BROADWAY STE PH1
Second Line :
City : JERICHO
State : NY
Zip : 11753-2025
Country : US
Telephone Number : 516-526-5993
Fax Number :
Provider Business Practice Location Address
First Line : 366 N BROADWAY STE PH1
Second Line :
City : JERICHO
State : NY
Zip : 11753-2025
Country : US
Telephone Number : 516-754-4158
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 03/17/2018

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Directions to “ GERARDA MCDOUGALL LCSW” Practice Location

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