Provider Demographics
NPI:1285750117
Name:MOGEL, GRETTA (LCSW)
Entity type:Individual
Prefix:MS
First Name:GRETTA
Middle Name:
Last Name:MOGEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W 87TH ST
Mailing Address - Street 2:1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3533
Mailing Address - Country:US
Mailing Address - Phone:212-724-6288
Mailing Address - Fax:212-724-6288
Practice Address - Street 1:30 W 87TH ST
Practice Address - Street 2:1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3533
Practice Address - Country:US
Practice Address - Phone:212-724-6288
Practice Address - Fax:212-724-6288
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036066-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN61302Medicare ID - Type UnspecifiedPROVIDER NUMBER
NYR036066-1Medicare UPIN