Provider Demographics
NPI:1740223833
Name:GERARDI, VINCENT THOMAS (LCSW - R, CASAC)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:THOMAS
Last Name:GERARDI
Suffix:
Gender:M
Credentials:LCSW - R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2574
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-6574
Mailing Address - Country:US
Mailing Address - Phone:518-429-9173
Mailing Address - Fax:
Practice Address - Street 1:206 GLEN ST STE 34
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3585
Practice Address - Country:US
Practice Address - Phone:518-429-9173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0742941041C0700X
NY12695101YA0400X
VT089-01090221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420800Medicaid
NYRB0796Medicare PIN