Provider Demographics
NPI:1619162021
Name:GERRY, EDWARD M (CASAC)
Entity Type:Individual
Prefix:MISS
First Name:EDWARD
Middle Name:M
Last Name:GERRY
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 E BROADWAY
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6803
Mailing Address - Country:US
Mailing Address - Phone:212-343-3564
Mailing Address - Fax:212-966-4176
Practice Address - Street 1:46 E BROADWAY
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6803
Practice Address - Country:US
Practice Address - Phone:212-343-3564
Practice Address - Fax:212-966-4176
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12743101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12743OtherCASAC