Provider Demographics
NPI:1003054271
Name:CHECA, GUSTAVO ANIBAL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:ANIBAL
Last Name:CHECA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 W 170TH ST
Mailing Address - Street 2:APT 1H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3512
Mailing Address - Country:US
Mailing Address - Phone:646-418-4346
Mailing Address - Fax:
Practice Address - Street 1:630 W 170TH ST
Practice Address - Street 2:APT 1H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3512
Practice Address - Country:US
Practice Address - Phone:646-418-4346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO48508-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical