Provider Demographics
NPI:1215296645
Name:GILMORE, LAMAR (LCSW)
Entity type:Individual
Prefix:MR
First Name:LAMAR
Middle Name:
Last Name:GILMORE
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 1:145-42 226TH STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3534
Mailing Address - Country:US
Mailing Address - Phone:347-645-4690
Mailing Address - Fax:718-527-7276
Practice Address - Street 1:119-29(A) 80TH ROAD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415
Practice Address - Country:US
Practice Address - Phone:347-645-4690
Practice Address - Fax:718-263-1811
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051640-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker