Healthcare Provider Details

I. General information

NPI: 1891903076
Provider Name (Legal Business Name): PENNY LYN GADZINI M.DIV.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 E ALLENDALE AVE
ALLENDALE NJ
07401-2095
US

IV. Provider business mailing address

65 E MALTBIE AVE
SUFFERN NY
10901-6007
US

V. Phone/Fax

Practice location:
  • Phone: 201-327-2424
  • Fax:
Mailing address:
  • Phone: 917-287-0583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: