Provider Demographics
NPI:1578382362
Name:GORGOROSO, PRICILLA JANELLE (MHC-LP)
Entity type:Individual
Prefix:
First Name:PRICILLA
Middle Name:JANELLE
Last Name:GORGOROSO
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E 96TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2521
Mailing Address - Country:US
Mailing Address - Phone:305-494-1413
Mailing Address - Fax:
Practice Address - Street 1:119 E 96TH ST
Practice Address - Street 2:APT 14
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2521
Practice Address - Country:US
Practice Address - Phone:305-494-1413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP131509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health