Provider Demographics
NPI:1295373108
Name:GEROULD, ANN MILLIKEN (LMSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MILLIKEN
Last Name:GEROULD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2562
Mailing Address - Country:US
Mailing Address - Phone:607-734-0980
Mailing Address - Fax:607-734-0981
Practice Address - Street 1:407 W WATER ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-2562
Practice Address - Country:US
Practice Address - Phone:607-734-0980
Practice Address - Fax:607-734-0981
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1062441104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker