Provider Demographics
NPI:1932342086
Name:GERSHOWITZ, PAMELA (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:GERSHOWITZ
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 1:69 WICHARD BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1725
Mailing Address - Country:US
Mailing Address - Phone:631-495-4976
Mailing Address - Fax:
Practice Address - Street 1:69 WICHARD BLVD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1725
Practice Address - Country:US
Practice Address - Phone:316-495-4976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-18
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077750-1104100000X
NY0815311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker