Provider Demographics
NPI:1497097661
Name:THOMAS, GILBERT (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
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 1:20417 HILLSIDE AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2213
Mailing Address - Country:US
Mailing Address - Phone:718-415-3832
Mailing Address - Fax:
Practice Address - Street 1:20417 HILLSIDE AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2213
Practice Address - Country:US
Practice Address - Phone:718-415-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075603-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical