Provider Demographics
NPI:1750860391
Name:GERLAK, PATRYCJA ANNA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRYCJA
Middle Name:ANNA
Last Name:GERLAK
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 1:53119 63RD ST
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1224
Mailing Address - Country:US
Mailing Address - Phone:347-889-8633
Mailing Address - Fax:
Practice Address - Street 1:53119 63RD ST
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1224
Practice Address - Country:US
Practice Address - Phone:347-889-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104366-1104100000X
NY092103011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker