Healthcare Provider Details

I. General information

NPI: 1548345986
Provider Name (Legal Business Name): GAIL A VODOPIJA LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. GAIL A PARIETTI

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 WAVERLY AVE SUITE 305
HOLTSVILLE NY
11742-1190
US

IV. Provider business mailing address

77 CEDARHURST AVE
SELDEN NY
11784-2907
US

V. Phone/Fax

Practice location:
  • Phone: 631-721-7422
  • Fax: 631-803-0394
Mailing address:
  • Phone: 631-721-7422
  • Fax: 631-803-0394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR-071721-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: