Provider Demographics
NPI:1720423817
Name:GAYLE, LORI SPENCER (MA, LADC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:SPENCER
Last Name:GAYLE
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WASHINGTON ST
Mailing Address - Street 2:SUITE 750
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2710
Mailing Address - Country:US
Mailing Address - Phone:203-829-2286
Mailing Address - Fax:
Practice Address - Street 1:50 WASHINGTON ST
Practice Address - Street 2:SUITE 750
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2710
Practice Address - Country:US
Practice Address - Phone:203-829-2286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000867101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)