Provider Demographics
NPI:1306903398
Name:GERRY, ROBIN MICHELE (LCSW-R)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:MICHELE
Last Name:GERRY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:M
Other - Last Name:GERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:1614 GOSHEN TPKE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-1056
Mailing Address - Country:US
Mailing Address - Phone:914-405-5675
Mailing Address - Fax:888-402-5207
Practice Address - Street 1:1614 GOSHEN TURNPIKE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941
Practice Address - Country:US
Practice Address - Phone:914-406-5675
Practice Address - Fax:888-402-5207
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY396941041C0700X
NY0396941041C0700X
NYR039694-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00542503Medicaid