Provider Demographics
NPI:1033126347
Name:GILL, MICHAEL S (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:GILL
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 E 7TH ST
Mailing Address - Street 2:APT. 23
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6011
Mailing Address - Country:US
Mailing Address - Phone:212-995-8717
Mailing Address - Fax:718-430-3960
Practice Address - Street 1:1165 MORRIS PARK AVE
Practice Address - Street 2:ROUSSO-119
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1915
Practice Address - Country:US
Practice Address - Phone:718-430-3942
Practice Address - Fax:718-430-3960
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health