Provider Demographics
NPI:1710289772
Name:GARGALA, JEAN MARIE (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARIE
Last Name:GARGALA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SWEETHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1881
Mailing Address - Country:US
Mailing Address - Phone:716-404-9765
Mailing Address - Fax:716-688-8684
Practice Address - Street 1:4955 N BAILEY AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1206
Practice Address - Country:US
Practice Address - Phone:717-404-9765
Practice Address - Fax:716-688-8684
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0732461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical