Basic Information
| Provider Information | |||||||||
| NPI: | 1467615880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOPI | ||||||||
| FirstName: | GEETANJEELLIE | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GOPI | ||||||||
| OtherFirstName: | GEETANJEELLIE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 FLATBUSH AVE | ||||||||
| Address2: | BROOKLYN CENTER FOR PSYCHOTHERAPY | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112172812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186222000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 FLATBUSH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112172812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186222000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2008 | ||||||||
| LastUpdateDate: | 11/30/2016 | ||||||||
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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 | 082479 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.