MEDICARE: MARIA T GAMBINO LMHC

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	101YM0800X	Mental Health Counselor	005677	NY

General Provider Information

NPI Number	:	1962835298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA T GAMBINO LMHC

Provider Business Mailing Address
First Line	:	41 UNION SQ W STE 325
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-3234
Country	:	US
Telephone Number	:	917-727-0133
Fax Number	:	877-977-7337

Provider Business Practice Location Address
First Line	:	41 UNION SQ W STE 325
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-3234
Country	:	US
Telephone Number	:	917-727-0133
Fax Number	:	877-977-7337

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

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	08/09/2013

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