Provider Demographics
NPI:1619122173
Name:REAGAN, GAIL BERNICE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:BERNICE
Last Name:REAGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 WARD ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1124
Mailing Address - Country:US
Mailing Address - Phone:510-292-7832
Mailing Address - Fax:510-295-2957
Practice Address - Street 1:2340 WARD ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1124
Practice Address - Country:US
Practice Address - Phone:510-292-7832
Practice Address - Fax:510-295-2957
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical