Gagnidze-Mccormick, Ketevan

Gagnidze-Mccormick, Ketevan is an sole proprietor health care provider with primary practice located at 10 Bruce St , Newburgh NY 12550-6602. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Social Worker. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Gagnidze-Mccormick, Ketevan can be contacted via phone (845) 561-7284.

Contact Information

Primary practice address
10 Bruce St Newburgh NY 12550-6602
Phone: (845) 561-7284
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 003123 New York
Behavioral Health & Social Service Providers / Professional 101YP2500X 37PC00314800 New Jersey
Behavioral Health & Social Service Providers / Social Worker 104100000X 44SW05190800 New Jersey

Profile Details

NPI number 1356661037
LBN Legal business name Gagnidze-Mccormick, Ketevan
Credentials LMHC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 4th, 2010
Last updated Jun 4th, 2010 - about 16 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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