Provider Demographics
NPI:1760009427
Name:GILMORE, GAYLA (MSW)
Entity Type:Individual
Prefix:MS
First Name:GAYLA
Middle Name:
Last Name:GILMORE
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 1:1439 METROPOLITAN AVE APT 5B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7422
Mailing Address - Country:US
Mailing Address - Phone:646-245-9952
Mailing Address - Fax:
Practice Address - Street 1:100 PARK AVE FL 16
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5538
Practice Address - Country:US
Practice Address - Phone:212-433-2384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health