Provider Demographics
NPI:1619946480
Name:GERSON, DARRIN WILLIAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DARRIN
Middle Name:WILLIAM
Last Name:GERSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 JOHN DR
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1541
Mailing Address - Country:US
Mailing Address - Phone:516-454-7584
Mailing Address - Fax:
Practice Address - Street 1:75 PROSPECT ST
Practice Address - Street 2:SUITE 206
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3382
Practice Address - Country:US
Practice Address - Phone:516-314-0251
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016157103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist