Provider Demographics
NPI:1396803102
Name:BARRACK, GAIL W (LCSW,ACSW)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:W
Last Name:BARRACK
Suffix:
Gender:F
Credentials:LCSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 BLOOMING GROVE TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7843
Mailing Address - Country:US
Mailing Address - Phone:845-496-2990
Mailing Address - Fax:
Practice Address - Street 1:555 BLOOMING GROVE TPKE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7843
Practice Address - Country:US
Practice Address - Phone:845-496-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR25812 11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7400171OtherGHI ID #
NYYS019OtherOXFORD INS. ID #