Provider Demographics
NPI:1972950616
Name:CIRLIN-LAZERUS, GAIL (LCSW)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:CIRLIN-LAZERUS
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 1:300 BROOKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-1406
Mailing Address - Country:US
Mailing Address - Phone:845-499-0480
Mailing Address - Fax:
Practice Address - Street 1:86 MEDWAY AVE
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-2825
Practice Address - Country:US
Practice Address - Phone:845-499-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079493104100000X
NY0905371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker