Provider Demographics
NPI:1336635457
Name:GORCHOV, JOLIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOLIE
Middle Name:
Last Name:GORCHOV
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 1:217 E 7TH ST APT 2J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2639
Mailing Address - Country:US
Mailing Address - Phone:347-907-4147
Mailing Address - Fax:
Practice Address - Street 1:7 W 30TH ST FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4406
Practice Address - Country:US
Practice Address - Phone:212-725-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103732261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)