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General NPI Number Information
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NPI Number | 1124132832
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Entity Type | Individual
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Provider Name | GAIL I MANDRA STALLONE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 445 BROADHOLLOW RD SUITE 228
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City | MELVILLE
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State | NY
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Zip | 11747-3669
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Country | US
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Telephone | 631-827-8200
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Fax | 631-501-1103
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Provider Business Mailing Address
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Address Line | 445 BROADHOLLOW RD SUITE 228
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City | MELVILLE
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State | NY
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Zip | 11747-3669
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Country | US
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Telephone | 631-827-8200
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Fax | 631-501-1103
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 053058-1
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License Number State | NY
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