Provider Demographics
NPI:1467660209
Name:COSGROVE, GINA MARIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIA
Last Name:COSGROVE
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 1:50 MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1670
Mailing Address - Country:US
Mailing Address - Phone:518-373-8944
Mailing Address - Fax:518-346-0783
Practice Address - Street 1:6 CHELSEA PL STE 202
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3236
Practice Address - Country:US
Practice Address - Phone:518-982-1886
Practice Address - Fax:518-734-0276
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014580103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent