Provider Demographics
NPI:1437668167
Name:GOCKLEY, COLEMAN BLAIR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:COLEMAN
Middle Name:BLAIR
Last Name:GOCKLEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2540
Mailing Address - Country:US
Mailing Address - Phone:585-235-2820
Mailing Address - Fax:585-464-6174
Practice Address - Street 1:190 REYNOLDS ST
Practice Address - Street 2:CLARA BARTON SCHOOL NO.2, RCSD
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608
Practice Address - Country:US
Practice Address - Phone:585-235-2820
Practice Address - Fax:585-464-6174
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091903-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool