Provider Demographics
NPI:1134475205
Name:GAWRYCH, AMY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:GAWRYCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 DEER PARK AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2833
Mailing Address - Country:US
Mailing Address - Phone:631-321-7107
Mailing Address - Fax:631-321-7108
Practice Address - Street 1:73 DEER PARK AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2833
Practice Address - Country:US
Practice Address - Phone:631-321-7107
Practice Address - Fax:631-321-7108
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019572103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral