Provider Demographics
NPI:1336303221
Name:PETIGROW, GAYLE BARBARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:BARBARA
Last Name:PETIGROW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DRIFTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7940
Mailing Address - Country:US
Mailing Address - Phone:631-462-6882
Mailing Address - Fax:
Practice Address - Street 1:10 DRIFTWOOD LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7940
Practice Address - Country:US
Practice Address - Phone:631-462-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011596-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist