Provider Demographics
NPI:1609271196
Name:GAMBINO, KERRIANN (MA)
Entity Type:Individual
Prefix:
First Name:KERRIANN
Middle Name:
Last Name:GAMBINO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4149
Mailing Address - Country:US
Mailing Address - Phone:516-385-5424
Mailing Address - Fax:
Practice Address - Street 1:61 WELLINGTON RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4149
Practice Address - Country:US
Practice Address - Phone:516-385-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY983770001103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool