Provider Demographics
NPI:1558811042
Name:KATZ, GARY
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 W 39TH ST
Mailing Address - Street 2:APT. 48C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-3824
Mailing Address - Country:US
Mailing Address - Phone:201-410-2629
Mailing Address - Fax:
Practice Address - Street 1:56 W 39TH ST
Practice Address - Street 2:APT. 48C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3824
Practice Address - Country:US
Practice Address - Phone:201-410-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0896731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical