Provider Demographics
NPI:1891847141
Name:GERTNER, ELLEN G (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:G
Last Name:GERTNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:G
Other - Last Name:HERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:391 KEARNY AVENUE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2603
Mailing Address - Country:US
Mailing Address - Phone:201-246-8077
Mailing Address - Fax:201-955-6165
Practice Address - Street 1:391 KEARNY AVENUE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2603
Practice Address - Country:US
Practice Address - Phone:201-246-8077
Practice Address - Fax:201-955-6165
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC45246104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
485523000OtherMAGELLAN
GE894296Medicare ID - Type Unspecified