Provider Demographics
NPI:1346260122
Name:BRICK, GAIL (LCSW-R)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:BRICK
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MAIN ST
Mailing Address - Street 2:SUITE # 309
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-1521
Mailing Address - Country:US
Mailing Address - Phone:845-207-9717
Mailing Address - Fax:845-207-9717
Practice Address - Street 1:155 MAIN ST
Practice Address - Street 2:SUITE # 309
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-1521
Practice Address - Country:US
Practice Address - Phone:845-207-9717
Practice Address - Fax:845-207-9717
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049011-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01898168Medicaid