Provider Demographics
NPI:1366460495
Name:GERSTEN-THORNBURG, IRIS J (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:J
Last Name:GERSTEN-THORNBURG
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:IRIS
Other - Middle Name:J
Other - Last Name:GERSTEN-THORNBURG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:457 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5206
Mailing Address - Country:US
Mailing Address - Phone:718-965-2555
Mailing Address - Fax:
Practice Address - Street 1:6729 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7063
Practice Address - Country:US
Practice Address - Phone:718-456-7001
Practice Address - Fax:718-456-9470
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO24501-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244624Medicaid
NY00244624Medicaid