Provider Demographics
NPI:1831470095
Name:GILLIES, JOHN JOSEPH III (LMSW, MSED)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:GILLIES
Suffix:III
Gender:M
Credentials:LMSW, MSED
Other - Prefix:
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Mailing Address - Street 1:752 W END AVE
Mailing Address - Street 2:APT 3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6230
Mailing Address - Country:US
Mailing Address - Phone:917-974-9414
Mailing Address - Fax:212-663-1808
Practice Address - Street 1:752 W END AVE
Practice Address - Street 2:APT 3C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6230
Practice Address - Country:US
Practice Address - Phone:917-974-9414
Practice Address - Fax:212-663-1808
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY084425-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical