Provider Demographics
NPI:1942428347
Name:FORMAN, GAYLE NOVACK (MSW)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:NOVACK
Last Name:FORMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 DIAMOND SPRING RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2770
Mailing Address - Country:US
Mailing Address - Phone:973-586-4454
Mailing Address - Fax:973-736-6554
Practice Address - Street 1:23 DIAMOND SPRING RD
Practice Address - Street 2:SUITE 6
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2770
Practice Address - Country:US
Practice Address - Phone:973-586-4454
Practice Address - Fax:973-736-6554
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC011705001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical