Provider Demographics
NPI:1063455228
Name:TROSCLAIR, GARY S (LCSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:S
Last Name:TROSCLAIR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HOLLYWOOD AVENUE EAST
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-3020
Mailing Address - Country:US
Mailing Address - Phone:212-254-1733
Mailing Address - Fax:914-337-0135
Practice Address - Street 1:16 HOLLYWOOD AVENUE E
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-3020
Practice Address - Country:US
Practice Address - Phone:212-254-1733
Practice Address - Fax:914-337-0135
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO45455-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7B702Medicare ID - Type Unspecified
NYN7B701Medicare ID - Type Unspecified