Provider Demographics
NPI:1821270224
Name:ESPOSITO, GERALD MARIO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:MARIO
Last Name:ESPOSITO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1222
Mailing Address - Country:US
Mailing Address - Phone:973-743-7916
Mailing Address - Fax:973-743-0025
Practice Address - Street 1:52 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1222
Practice Address - Country:US
Practice Address - Phone:973-743-7916
Practice Address - Fax:973-743-0025
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO22532-11041C0700X
NYRO225321-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01960609Medicaid