Provider Demographics
NPI:1053305912
Name:GILBERT, JERI E (PHD)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:E
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BAY CLUB DR
Mailing Address - Street 2:APT 3E
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2919
Mailing Address - Country:US
Mailing Address - Phone:718-589-8324
Mailing Address - Fax:718-378-2880
Practice Address - Street 1:2391 BELL BLVD
Practice Address - Street 2:STE 202
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2019
Practice Address - Country:US
Practice Address - Phone:718-589-8324
Practice Address - Fax:718-378-2880
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008740103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00665274Medicaid
NY00665274Medicaid