Provider Demographics
NPI:1407361181
Name:FIORELLA, GINA MARIE (LCSW, LMSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:FIORELLA
Suffix:
Gender:F
Credentials:LCSW, LMSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 20TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-1253
Mailing Address - Country:US
Mailing Address - Phone:646-685-4422
Mailing Address - Fax:
Practice Address - Street 1:159 20TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-1253
Practice Address - Country:US
Practice Address - Phone:646-685-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2021-08-11
Deactivation Date:2018-02-21
Deactivation Code:
Reactivation Date:2020-05-28
Provider Licenses
StateLicense IDTaxonomies
NY097757104100000X
NJ44SL06192600104100000X
NY0916041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285628552OtherAGENCY: ANDRUS