Provider Demographics
NPI:1770048431
Name:MORSELLINO, GAIL
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:
Last Name:MORSELLINO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GAIL
Other - Middle Name:PATRICIA
Other - Last Name:CASTELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-2012
Mailing Address - Country:US
Mailing Address - Phone:516-887-3686
Mailing Address - Fax:
Practice Address - Street 1:120 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-2012
Practice Address - Country:US
Practice Address - Phone:516-887-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211465252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency