MEDICARE: ALICE GAMMAL M.S.ED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YS0200X	School Counselor
3	103K00000X	Behavior Analyst
4	103T00000X	Psychologist
5	103TC1900X	Counseling Psychologist
6	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1225342272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE GAMMAL M.S.ED

Provider Business Mailing Address
First Line	:	1350 E 4TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 E 4TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4606
Country	:	US
Telephone Number	:	917-453-6057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2010
Last Update Date	:	08/02/2010

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