Provider Demographics
NPI:1770684102
Name:GOSCINSKY, MICHELLE L (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:GOSCINSKY
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:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:TALLMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10982-0236
Mailing Address - Country:US
Mailing Address - Phone:212-372-3113
Mailing Address - Fax:
Practice Address - Street 1:50 SANITORIUM RD
Practice Address - Street 2:BLFG F-ROOM 240
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3555
Practice Address - Country:US
Practice Address - Phone:845-364-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0550641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical