1437162567 NPI number — CAROLYN GARVEY-GORDON LCSW

Table of content: CAROLYN GARVEY-GORDON LCSW (NPI 1437162567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437162567 NPI number — CAROLYN GARVEY-GORDON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARVEY-GORDON
Provider First Name:
CAROLYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437162567
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 OLD COURTHOUSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-1115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-365-7858
Provider Business Mailing Address Fax Number:
516-365-3526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 OLD COURTHOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11040-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-365-7858
Provider Business Practice Location Address Fax Number:
516-365-3526
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R0275911 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0069364 . This is a "GHI PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 76086949 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 108741 . This is a "MHN PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 049971000 . This is a "MAGELLAN MIS #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 22162 . This is a "VYTRA PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0005088691 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112794161 . This is a "CIGNA PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AS138 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N13721 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 025204 . This is a "VALUEOPTIONS PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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