Provider Demographics
NPI:1194987271
Name:PETERSON, GAIL (LCSW-R)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ENGLISH ROAD PSYCHOTHERAPY
Mailing Address - Street 2:1800 ENGLISH ROAD
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616
Mailing Address - Country:US
Mailing Address - Phone:585-225-9720
Mailing Address - Fax:
Practice Address - Street 1:ENGLISH ROAD PSYCHOTHERAPY
Practice Address - Street 2:1800 ENGLISH ROAD
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616
Practice Address - Country:US
Practice Address - Phone:585-225-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO47437-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health