Provider Demographics
NPI:1104928217
Name:GADOL, JERRY K (MA LCSW)
Entity type:Individual
Prefix:MRS
First Name:JERRY
Middle Name:K
Last Name:GADOL
Suffix:
Gender:F
Credentials:MA LCSW
Other - Prefix:MRS
Other - First Name:JERRY
Other - Middle Name:J
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9411 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-1522
Mailing Address - Country:US
Mailing Address - Phone:214-341-9386
Mailing Address - Fax:
Practice Address - Street 1:12800 HILLCREST RD
Practice Address - Street 2:SUITE 124
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1524
Practice Address - Country:US
Practice Address - Phone:972-233-1630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0112561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical