Provider Demographics
NPI:1962835298
Name:GAMBINO, MARIA T (LMHC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:GAMBINO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 UNION SQ W STE 325
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3234
Mailing Address - Country:US
Mailing Address - Phone:917-727-0133
Mailing Address - Fax:877-977-7337
Practice Address - Street 1:41 UNION SQ W STE 325
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3234
Practice Address - Country:US
Practice Address - Phone:917-727-0133
Practice Address - Fax:877-977-7337
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health