Provider Information for 1073889994
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Mr. VAKHTANG GOMELAURI LCSW
Sex: Male
NPI: 1073889994
Last Updated: 2022-07-21
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1073889994 | ||||||||||||
| Enumeration Date | 2012-03-25 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 26 COURT ST STE 1009 BROOKLYN, NY 11242-1110 United States Phone: 347-699-8910 | Fax:267-378-9424 | ||||||||||||
| Primary Practice Address | 26 COURT ST STE 1009 BROOKLYN, NY 11242-1110 United States Phone: 347-699-8910 | Fax:267-378-9424 | ||||||||||||
| Secondary Practice Address(es) | 180 LIVINGSTON ST | ||||||||||||
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