Provider Demographics
NPI:1447772033
Name:FELICIA GLENN GERROL, PH.D., INC
Entity Type:Organization
Organization Name:FELICIA GLENN GERROL, PH.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:GERROL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-221-8518
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011469103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty