Provider Demographics
NPI:1093836835
Name:GORMAN, ELLEN L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:L
Last Name:GORMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W 16TH ST
Mailing Address - Street 2:APT. 4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6284
Mailing Address - Country:US
Mailing Address - Phone:212-691-8583
Mailing Address - Fax:212-691-8908
Practice Address - Street 1:151 W 16TH ST
Practice Address - Street 2:APT. 4B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6284
Practice Address - Country:US
Practice Address - Phone:212-691-8583
Practice Address - Fax:212-691-8908
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR013414-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical