MEDICARE: MS. LAURIE D. GILKES LCSW,BCD

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	1041C0700X	Clinical Social Worker	PR012668-1	NY

General Provider Information

NPI Number	:	1871590034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE D. GILKES LCSW,BCD

Provider Business Mailing Address
First Line	:	330 E 79TH ST
Second Line	:	APT. 1G
City	:	NEW YORK
State	:	NY
Zip	:	10021-0966
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	:	APT. 1G
City	:	NEW YORK
State	:	NY
Zip	:	10021-0966
Country	:	US
Telephone Number	:	212-737-0560
Fax Number	:	212-737-0560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2005
Last Update Date	:	07/08/2007

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