Provider Demographics
NPI:1922028984
Name:GITLIN, BONNIE ELLEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:ELLEN
Last Name:GITLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 W END AVE
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6815
Mailing Address - Country:US
Mailing Address - Phone:212-665-6249
Mailing Address - Fax:212-662-1767
Practice Address - Street 1:680 W END AVE
Practice Address - Street 2:SUITE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6815
Practice Address - Country:US
Practice Address - Phone:212-665-6249
Practice Address - Fax:212-662-1767
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017953R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN10371Medicare ID - Type Unspecified