Provider Demographics
NPI:1265759021
Name:GOURLEY, GERALDINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:
Last Name:GOURLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GERI
Other - Middle Name:
Other - Last Name:GOURLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, CPC
Mailing Address - Street 1:7 MARKHAM CIR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-5039
Mailing Address - Country:US
Mailing Address - Phone:201-214-8861
Mailing Address - Fax:
Practice Address - Street 1:700 E PALISADE AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-3058
Practice Address - Country:US
Practice Address - Phone:201-414-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCO53629001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical