Healthcare Provider Details

I. General information

NPI: 1679202451
Provider Name (Legal Business Name): MICHAEL THOMAS GAITO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 COLTON AVE
SAYVILLE NY
11782-3108
US

IV. Provider business mailing address

124 COLTON AVE
SAYVILLE NY
11782-3108
US

V. Phone/Fax

Practice location:
  • Phone: 631-793-0338
  • Fax:
Mailing address:
  • Phone: 631-793-0338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number092598-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: