Provider Demographics
NPI:1538409917
Name:GOSIN, MEREDITH BLAKE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:BLAKE
Last Name:GOSIN
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 1:84 BIRCH HILL RD
Mailing Address - Street 2:REAR COTTAGE
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-1838
Mailing Address - Country:US
Mailing Address - Phone:516-840-8598
Mailing Address - Fax:516-801-2705
Practice Address - Street 1:84 BIRCH HILL RD
Practice Address - Street 2:REAR COTTAGE
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-1838
Practice Address - Country:US
Practice Address - Phone:516-840-8598
Practice Address - Fax:516-801-2705
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072219-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical