Provider Demographics
NPI:1235227612
Name:GERROL, FELICIA GLENN (PHD)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:GLENN
Last Name:GERROL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROSEMARY DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2700
Mailing Address - Country:US
Mailing Address - Phone:518-221-8518
Mailing Address - Fax:518-453-2326
Practice Address - Street 1:1 ROSEMARY DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2700
Practice Address - Country:US
Practice Address - Phone:518-221-8518
Practice Address - Fax:518-453-2326
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011469103TC0700X, 103T00000X
NY11469103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01938485Medicaid