Provider Demographics
NPI:1871656785
Name:BABAD, GARY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:BABAD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7752 251ST ST
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-2606
Mailing Address - Country:US
Mailing Address - Phone:718-470-6851
Mailing Address - Fax:718-470-6851
Practice Address - Street 1:7752 251ST ST
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-2606
Practice Address - Country:US
Practice Address - Phone:718-470-6851
Practice Address - Fax:718-470-6851
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0239911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07298Medicare ID - Type UnspecifiedGHI MEDICARE