Provider Demographics
NPI:1407021959
Name:PANTALEO, GAYLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:
Last Name:PANTALEO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 2296
Mailing Address - Street 2:
Mailing Address - City:NEW PRESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06777
Mailing Address - Country:US
Mailing Address - Phone:860-927-3398
Mailing Address - Fax:860-927-1844
Practice Address - Street 1:17 OLD BARN ROAD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757
Practice Address - Country:US
Practice Address - Phone:860-927-3398
Practice Address - Fax:860-927-1844
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0021721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical