Provider Demographics
NPI:1134872880
Name:ISRAELSON, GAIL SANDRA (LP)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:SANDRA
Last Name:ISRAELSON
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W 116TH ST APT B505
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-0996
Mailing Address - Country:US
Mailing Address - Phone:917-361-0860
Mailing Address - Fax:
Practice Address - Street 1:40 W 116TH ST APT B505
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-0996
Practice Address - Country:US
Practice Address - Phone:917-361-0860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001002-01103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis