Provider Demographics
NPI:1811046618
Name:GORIS, EVELYN M
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:M
Last Name:GORIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MERCER ST
Mailing Address - Street 2:SUITE 11E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6724
Mailing Address - Country:US
Mailing Address - Phone:917-374-8358
Mailing Address - Fax:
Practice Address - Street 1:300 MERCER ST
Practice Address - Street 2:SUITE 11E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6724
Practice Address - Country:US
Practice Address - Phone:917-374-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0226961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical