Basic Information
| Provider Information | |||||||||
| NPI: | 1003012071 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARGIULO | ||||||||
| FirstName: | ANN MARIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2375 SOUTHERN BLVD | ||||||||
| Address2: | APT 2B | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104601028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185841668 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 FORDHAM PLZ | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184054400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 072286 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.