Provider Demographics
NPI:1134625692
Name:GORMLEY, EMMETT ROSE (LCSW)
Entity type:Individual
Prefix:
First Name:EMMETT
Middle Name:ROSE
Last Name:GORMLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:EM
Other - Middle Name:ROSE
Other - Last Name:GORMLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:900 S 49TH ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3480
Mailing Address - Country:US
Mailing Address - Phone:484-416-6122
Mailing Address - Fax:
Practice Address - Street 1:33 S 9TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:484-416-6122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133443104100000X
PACW0202811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker