Provider Demographics
NPI:1164575510
Name:GERSON, IRA HARVEY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:IRA
Middle Name:HARVEY
Last Name:GERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 FDR DR
Mailing Address - Street 2:K604
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-2024
Mailing Address - Country:US
Mailing Address - Phone:212-533-4988
Mailing Address - Fax:212-423-6534
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:4M17
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7404
Practice Address - Country:US
Practice Address - Phone:212-423-8259
Practice Address - Fax:212-423-6388
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR016541-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY979476OtherPROVIDER NUMBER
NYR016541-1OtherN.Y.S LICENSE NUMBER