Provider Demographics
NPI:1003278912
Name:PARKER, GERTRUDE ELAINE (LMSW)
Entity Type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:ELAINE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:GERTRUDE
Other - Middle Name:ELAINE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:117 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2236
Mailing Address - Country:US
Mailing Address - Phone:212-724-6300
Mailing Address - Fax:
Practice Address - Street 1:117 W 74TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2236
Practice Address - Country:US
Practice Address - Phone:212-724-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086019171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator