Provider Demographics
NPI:1467437095
Name:POWELL, GORDON STUART (LCSW)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:STUART
Last Name:POWELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 26TH ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6813
Mailing Address - Country:US
Mailing Address - Phone:212-929-3715
Mailing Address - Fax:212-929-3715
Practice Address - Street 1:150 W 26TH ST
Practice Address - Street 2:SUITE 601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6813
Practice Address - Country:US
Practice Address - Phone:212-929-3715
Practice Address - Fax:212-929-3715
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040311-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR040311-1OtherNYS SOCIAL WORK LICENSE
NYN8B571Medicare ID - Type Unspecified