Provider Demographics
NPI:1790757656
Name:GERSHON, TALYA (LCSW)
Entity Type:Individual
Prefix:
First Name:TALYA
Middle Name:
Last Name:GERSHON
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 1:2580 POTTERS RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4324
Mailing Address - Country:US
Mailing Address - Phone:757-498-9391
Mailing Address - Fax:757-498-7073
Practice Address - Street 1:2580 POTTERS RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4324
Practice Address - Country:US
Practice Address - Phone:757-498-9391
Practice Address - Fax:757-498-7073
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA003480P31Medicare ID - Type Unspecified