Provider Demographics
NPI:1326038050
Name:MUNZ, GLORIA D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:D
Last Name:MUNZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 PIKE ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-1808
Mailing Address - Country:US
Mailing Address - Phone:845-858-1456
Mailing Address - Fax:845-858-1459
Practice Address - Street 1:146 PIKE ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1808
Practice Address - Country:US
Practice Address - Phone:845-858-1456
Practice Address - Fax:845-858-1459
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0700471104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00542503Medicaid
NY00542503Medicaid
W06181Medicare ID - Type Unspecified