Provider Demographics
NPI:1093918443
Name:GUNZBURG, MARTHA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:GUNZBURG
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 1:7 W 96TH ST
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6540
Mailing Address - Country:US
Mailing Address - Phone:212-864-3924
Mailing Address - Fax:212-722-0727
Practice Address - Street 1:7 W 96TH ST
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6540
Practice Address - Country:US
Practice Address - Phone:212-864-3924
Practice Address - Fax:212-722-0727
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19 000441102L00000X
NYR0076991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN58131Medicare ID - Type Unspecified