Provider Demographics
NPI:1609933183
Name:MENENDEZ, GINA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:MENENDEZ
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 1:37 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4219
Mailing Address - Country:US
Mailing Address - Phone:914-734-1359
Mailing Address - Fax:914-734-1638
Practice Address - Street 1:612 DEPEW STREET
Practice Address - Street 2:WOODSIDE ELEMENTARY SCHOOL
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566
Practice Address - Country:US
Practice Address - Phone:914-734-1359
Practice Address - Fax:914-734-1638
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0701671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7P001Medicare ID - Type Unspecified