Provider Demographics
NPI:1235291030
Name:LENCZ, GAIL SISSELMAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:SISSELMAN
Last Name:LENCZ
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 1:654 MADISON AVE
Mailing Address - Street 2:SUITE 1905
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-8404
Mailing Address - Country:US
Mailing Address - Phone:917-957-4245
Mailing Address - Fax:646-349-2780
Practice Address - Street 1:654 MADISON AVE
Practice Address - Street 2:SUITE 1905
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8404
Practice Address - Country:US
Practice Address - Phone:917-957-4245
Practice Address - Fax:646-349-2780
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013707103TA0700X, 103TC0700X, 103TF0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2753984OtherOXFORD HEALTH PROVIDER ID
NYP2753984OtherOXFORD HEALTH PROVIDER ID