Provider Demographics
NPI:1427773423
Name:UKO-IMA, GLAD EFFY
Entity type:Individual
Prefix:
First Name:GLAD
Middle Name:EFFY
Last Name:UKO-IMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SCRIBNER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2317
Mailing Address - Country:US
Mailing Address - Phone:347-681-0419
Mailing Address - Fax:
Practice Address - Street 1:100 S BEDFORD RD OFC 321
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3425
Practice Address - Country:US
Practice Address - Phone:718-887-1257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP117276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty