Provider Demographics
NPI:1598005894
Name:GITELSON, MOLLY J (LCSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:J
Last Name:GITELSON
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 1:1400 PELHAM PARKWAY SOUTH
Mailing Address - Street 2:ROOM 1E4
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:718-918-4401
Mailing Address - Fax:718-918-7772
Practice Address - Street 1:1400 PELHAM PARKWAY SOUTH ROOM 1E4
Practice Address - Street 2:JACOBI MEDICAL CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471
Practice Address - Country:US
Practice Address - Phone:718-918-4401
Practice Address - Fax:718-918-7772
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2016-02-25
Deactivation Date:2014-05-21
Deactivation Code:
Reactivation Date:2016-02-11
Provider Licenses
StateLicense IDTaxonomies
NY075422-1104100000X
NY083706-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker