Provider Demographics
NPI:1447382148
Name:SCHWARTZ-BORDEN, GWEN D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:D
Last Name:SCHWARTZ-BORDEN
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 1:20 AMHERST PL
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5905
Mailing Address - Country:US
Mailing Address - Phone:516-799-4087
Mailing Address - Fax:
Practice Address - Street 1:20 AMHERST PL
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5905
Practice Address - Country:US
Practice Address - Phone:516-799-4087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO23497-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0089965OtherGHI
NY079665OtherVALUE OPTIONS
NO2261Medicare ID - Type Unspecified