Provider Demographics
NPI:1609933860
Name:DEMBY, GLORIA (MSW)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:
Last Name:DEMBY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 HENRY ST
Mailing Address - Street 2:GARDEN LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3011
Mailing Address - Country:US
Mailing Address - Phone:718-797-3260
Mailing Address - Fax:718-797-3260
Practice Address - Street 1:465 HENRY ST
Practice Address - Street 2:GARDEN LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3011
Practice Address - Country:US
Practice Address - Phone:718-797-3260
Practice Address - Fax:718-797-3260
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR 032864-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7499828Medicare UPIN
NYNA4082Medicare ID - Type Unspecified