Provider Demographics
NPI:1508076068
Name:MOORE, GAIL LAUREN (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:LAUREN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WASHINGTON AVE #5H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225
Mailing Address - Country:US
Mailing Address - Phone:718-483-4952
Mailing Address - Fax:
Practice Address - Street 1:26 COURT STREET
Practice Address - Street 2:SUITE 600 & 904
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242
Practice Address - Country:US
Practice Address - Phone:718-483-4952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002926101YM0800X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health