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NPI Code Detail

MEDICARE: PETER GEORGE GILLESPIE LCSW

MEDICARE:   PETER GEORGE GILLESPIE  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
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker083861-1NY

General Provider Information

NPI Number : 1417264813
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER GEORGE GILLESPIE LCSW
Provider Business Mailing Address
First Line : 141 N 4TH ST
Second Line : 2ND FLOOR
City : BROOKLYN
State : NY
Zip : 11211-3216
Country : US
Telephone Number : 917-602-1846
Fax Number :
Provider Business Practice Location Address
First Line : 141 N 4TH ST
Second Line : 2ND FLOOR
City : BROOKLYN
State : NY
Zip : 11211-3216
Country : US
Telephone Number : 212-989-2990
Fax Number : 212-792-6058
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2010
Last Update Date : 02/06/2020

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Directions to “ PETER GEORGE GILLESPIE LCSW” Practice Location

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