Provider Demographics
NPI:1316453525
Name:GOLD, GINA (GINA)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:GINA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W 96TH ST APT 12N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-9232
Mailing Address - Country:US
Mailing Address - Phone:212-662-6156
Mailing Address - Fax:212-662-6156
Practice Address - Street 1:75 MAIDEN LN # 208
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4810
Practice Address - Country:US
Practice Address - Phone:917-519-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001000103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis