Provider Demographics
NPI:1710118823
Name:GADDY, MICHAEL A (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:GADDY
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 AVENUE P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1106
Mailing Address - Country:US
Mailing Address - Phone:718-954-3800
Mailing Address - Fax:718-954-3767
Practice Address - Street 1:1300 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1106
Practice Address - Country:US
Practice Address - Phone:718-954-3800
Practice Address - Fax:718-954-3767
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20174101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)