Healthcare Provider Details

I. General information

NPI: 1861085219
Provider Name (Legal Business Name): GINA LAIRD CATLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 GEYSER RD
BALLSTON SPA NY
12020-3007
US

IV. Provider business mailing address

1910 HUNTRIDGE DR
CLIFTON PARK NY
12065-7161
US

V. Phone/Fax

Practice location:
  • Phone: 518-289-2720
  • Fax:
Mailing address:
  • Phone: 518-630-1038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102098-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: