Provider Demographics
NPI:1801109863
Name:DEMAIO - HERRERA, GLORIA (LCSW)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:DEMAIO - HERRERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:DEMAIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 GROVE AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2302
Mailing Address - Country:US
Mailing Address - Phone:516-350-8564
Mailing Address - Fax:
Practice Address - Street 1:45 N VILLAGE AVE STE 1B
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4610
Practice Address - Country:US
Practice Address - Phone:516-350-8564
Practice Address - Fax:516-874-2477
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72069431104100000X
NY0804451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker