Provider Demographics
NPI:1720856511
Name:HARRIS, GAIL
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:S
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:25314 85TH RD
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-2126
Mailing Address - Country:US
Mailing Address - Phone:917-837-5308
Mailing Address - Fax:
Practice Address - Street 1:1600 CENTRAL AVE FL 2
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4008
Practice Address - Country:US
Practice Address - Phone:718-868-1400
Practice Address - Fax:718-327-5615
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY092104-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)