Provider Demographics
NPI:1063572444
Name:FREUNDLICH, GAIL RUTH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:RUTH
Last Name:FREUNDLICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 CHESTERFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1005
Mailing Address - Country:US
Mailing Address - Phone:914-528-7946
Mailing Address - Fax:914-528-7946
Practice Address - Street 1:3730 CHESTERFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1005
Practice Address - Country:US
Practice Address - Phone:914-528-7946
Practice Address - Fax:914-528-7946
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0262101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY137887OtherVALUE OPTIONS
NY7402914OtherGHI
NYN28991Medicare ID - Type Unspecified
NY137887OtherVALUE OPTIONS