Provider Demographics
NPI:1114051307
Name:FOGELMAN-UNGER, GILA (CSW)
Entity Type:Individual
Prefix:MRS
First Name:GILA
Middle Name:
Last Name:FOGELMAN-UNGER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VAN OVER DR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3757
Mailing Address - Country:US
Mailing Address - Phone:732-679-5132
Mailing Address - Fax:
Practice Address - Street 1:140 8TH AVE
Practice Address - Street 2:4F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1767
Practice Address - Country:US
Practice Address - Phone:718-622-2906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR016502-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical