Provider Demographics
NPI:1770856122
Name:KALIKOW, GWEN LEVINE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:LEVINE
Last Name:KALIKOW
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GRACE DR
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1221
Mailing Address - Country:US
Mailing Address - Phone:516-625-0028
Mailing Address - Fax:516-626-0639
Practice Address - Street 1:10 GRACE DR
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1221
Practice Address - Country:US
Practice Address - Phone:516-625-0028
Practice Address - Fax:516-626-0639
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024702-1171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator