Provider Demographics
NPI:1538327663
Name:FAITHEAD, GLORIA LORRAINE I (CASAC)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:LORRAINE
Last Name:FAITHEAD
Suffix:I
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 LAKELAND AVE
Mailing Address - Street 2:APT 4G
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1930
Mailing Address - Country:US
Mailing Address - Phone:631-750-5086
Mailing Address - Fax:
Practice Address - Street 1:SUFFOLK COUNTY DEPARTMENT OF HEALTH
Practice Address - Street 2:DAY REPORTING CENTER N COUNTY COMPLEX BLDG#16
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-853-6277
Practice Address - Fax:631-853-6254
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11889101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)