Provider Demographics
NPI:1447409776
Name:MAMPOSO, GISELA (LCSW-R)
Entity Type:Individual
Prefix:MISS
First Name:GISELA
Middle Name:
Last Name:MAMPOSO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 QUEENS BLVD
Mailing Address - Street 2:APT 15F
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7757
Mailing Address - Country:US
Mailing Address - Phone:718-429-5753
Mailing Address - Fax:
Practice Address - Street 1:11835 QUEENS BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7200
Practice Address - Country:US
Practice Address - Phone:347-432-4134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400123391OtherMEDICARE PTAN