Provider Demographics
NPI:1770862369
Name:GAULT, DENNIS (MA, MS)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:GAULT
Suffix:
Gender:M
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RIVER TER APT 1E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282-1204
Mailing Address - Country:US
Mailing Address - Phone:212-227-2988
Mailing Address - Fax:
Practice Address - Street 1:20 RIVER TER APT 1E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10282-1204
Practice Address - Country:US
Practice Address - Phone:212-227-2988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088292011103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYOVOX62OtherHAND IN HAND DEVELOPMENT, INC.