Provider Demographics
NPI:1063564557
Name:COURTEMANCHE, GAIL A (LMSW)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:A
Last Name:COURTEMANCHE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 CULVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2362
Mailing Address - Country:US
Mailing Address - Phone:585-244-8785
Mailing Address - Fax:
Practice Address - Street 1:5130 E MAIN STREET RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3433
Practice Address - Country:US
Practice Address - Phone:585-344-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067144-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker