Peacock, Gina Vincenza

Peacock, Gina Vincenza is an individual health care provider with primary practice located at 3043 State Route 4 , Hudson Falls NY 12839-9632. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Peacock, Gina Vincenza can be contacted via phone (518) 747-2284.

Contact Information

Primary practice address
3043 State Route 4 Hudson Falls NY 12839-9632
Phone: (518) 747-2284
Fax: (518) 747-2253
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 00082239 New York
Behavioral Health & Social Service Providers / Clinical 1041C0700X 00082746 New York

Profile Details

NPI number 1164714606
LBN Legal business name Peacock, Gina Vincenza
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date May 3rd, 2011
Last updated Mar 26th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164714606 NPPES
New York MEDICAID 00082746
New York MEDICAID 00082239

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