Provider Demographics
NPI:1982458568
Name:GILLIS, NAIOMI ZIPPORAH (LMSW)
Entity Type:Individual
Prefix:
First Name:NAIOMI
Middle Name:ZIPPORAH
Last Name:GILLIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 ISHAM ST BSMT SUPT
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2128
Mailing Address - Country:US
Mailing Address - Phone:917-471-0643
Mailing Address - Fax:
Practice Address - Street 1:511 W 157TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-7601
Practice Address - Country:US
Practice Address - Phone:212-781-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123023104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker