Provider Demographics
NPI:1013170216
Name:AVERY, GLORIA (LCSW , 'R')
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:LCSW , 'R'
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:GLORIA
Other - Last Name:AVERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWR
Mailing Address - Street 1:450 W 42ND ST APT 15C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6871
Mailing Address - Country:US
Mailing Address - Phone:212-960-8560
Mailing Address - Fax:
Practice Address - Street 1:450 W 42ND ST APT 15C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6871
Practice Address - Country:US
Practice Address - Phone:212-960-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0308761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical