Provider Demographics
NPI:1831489962
Name:GAMBINO, PETER (LMSW)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:GAMBINO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 AUSTIN STREET
Mailing Address - Street 2:3X
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415
Mailing Address - Country:US
Mailing Address - Phone:917-579-7482
Mailing Address - Fax:
Practice Address - Street 1:8340 AUSTIN ST APT 3X
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1812
Practice Address - Country:US
Practice Address - Phone:917-579-7482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082889-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical