Provider Demographics
NPI:1003092958
Name:LAURIE D GILKES LCSW PC
Entity Type:Organization
Organization Name:LAURIE D GILKES LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILKES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW PC
Authorized Official - Phone:212-737-0560
Mailing Address - Street 1:330 E 79TH ST
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0966
Mailing Address - Country:US
Mailing Address - Phone:212-737-0560
Mailing Address - Fax:212-737-0560
Practice Address - Street 1:330 E 79TH ST
Practice Address - Street 2:SUITE 1G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0966
Practice Address - Country:US
Practice Address - Phone:212-737-0560
Practice Address - Fax:212-737-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR012668-1261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN09991Medicare PIN