Provider Demographics
NPI:1013217173
Name:GAYLE, ADRIAN G (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:G
Last Name:GAYLE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 S. CLINTON ST.
Mailing Address - Street 2:MAILSTOP CT 05-13
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224
Mailing Address - Country:US
Mailing Address - Phone:410-953-1905
Mailing Address - Fax:
Practice Address - Street 1:1501 S. CLINTON ST.
Practice Address - Street 2:MAILSTOP CT 05-13
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:410-953-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500789371041C0700X
MD163091041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical