Provider Demographics
NPI:1760546063
Name:AZAR, GAIL FRAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:FRAN
Last Name:AZAR
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 1:477 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2215
Mailing Address - Country:US
Mailing Address - Phone:973-746-4475
Mailing Address - Fax:
Practice Address - Street 1:477 GROVE ST
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-2215
Practice Address - Country:US
Practice Address - Phone:973-746-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051703001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ063646Medicare PIN