Provider Demographics
NPI:1538135769
Name:GARFINKLE, GERALDINE H (LCSW)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:H
Last Name:GARFINKLE
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 1:24 HOLLY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1710
Mailing Address - Country:US
Mailing Address - Phone:845-679-0704
Mailing Address - Fax:845-679-5485
Practice Address - Street 1:MAVERICK FAMILY COUNSELING
Practice Address - Street 2:404 ZENA RD
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1710
Practice Address - Country:US
Practice Address - Phone:845-679-8650
Practice Address - Fax:845-679-5485
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032928-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR032928-1OtherNY SOCIAL WORK LICENSE
NYN59261Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER
NYN59262Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER