Provider Demographics
NPI:1811207061
Name:GORIS, ANDRES E (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:E
Last Name:GORIS
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16019 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1808
Mailing Address - Country:US
Mailing Address - Phone:718-461-8630
Mailing Address - Fax:718-264-4993
Practice Address - Street 1:18417 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1729
Practice Address - Country:US
Practice Address - Phone:917-225-3298
Practice Address - Fax:718-264-4993
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0441011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical