Provider Demographics
NPI:1194186627
Name:GLEYZER, MARGARITA GERSHIK (LCSW, MA)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:GERSHIK
Last Name:GLEYZER
Suffix:
Gender:F
Credentials:LCSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12786-0037
Mailing Address - Country:US
Mailing Address - Phone:917-414-9398
Mailing Address - Fax:
Practice Address - Street 1:544 BROADWAY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1174
Practice Address - Country:US
Practice Address - Phone:917-414-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066652104100000X
NY0850721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker