Provider Demographics
NPI:1174651806
Name:HARA, GARY MASASHI (MA, LCAT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MASASHI
Last Name:HARA
Suffix:
Gender:M
Credentials:MA, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E 83RD ST
Mailing Address - Street 2:APT 5W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7253
Mailing Address - Country:US
Mailing Address - Phone:212-879-8317
Mailing Address - Fax:212-794-3057
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:BEHAVIORAL HEALTH-BUILDING #1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-6728
Practice Address - Fax:718-918-7783
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000083-1101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor