Healthcare Provider Details

I. General information

NPI: 1053713370
Provider Name (Legal Business Name): LANA GAITON PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BROADWAY SUITE 3400
NEW YORK NY
10007-3001
US

IV. Provider business mailing address

2 CHARLTON ST #11H
NEW YORK NY
10014-4909
US

V. Phone/Fax

Practice location:
  • Phone: 347-613-2708
  • Fax:
Mailing address:
  • Phone: 347-613-2708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number016868
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73 073064
License Number StateNY

VIII. Authorized Official

Name: DR. LANA GAITON
Title or Position: OWNER
Credential: PH.D.
Phone: 347-613-2708