Provider Demographics
NPI:1285854786
Name:FISHBEIN, GARY (LCSW, CEAP)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:FISHBEIN
Suffix:
Gender:M
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 RIVERSIDE DR
Mailing Address - Street 2:4-C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3404
Mailing Address - Country:US
Mailing Address - Phone:212-663-3865
Mailing Address - Fax:
Practice Address - Street 1:345 RIVERSIDE DR
Practice Address - Street 2:4-C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3404
Practice Address - Country:US
Practice Address - Phone:212-663-3865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070177-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical