Healthcare Provider Details

I. General information

NPI: 1780365692
Provider Name (Legal Business Name): HALEY GASIEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 HARRISTOWN RD STE 209
GLEN ROCK NJ
07452-3321
US

IV. Provider business mailing address

197 WALLINGTON AVE FL 2
WALLINGTON NJ
07057-1228
US

V. Phone/Fax

Practice location:
  • Phone: 201-564-7331
  • Fax:
Mailing address:
  • Phone: 201-625-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01236000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: