Provider Demographics
NPI:1770716060
Name:GAZLAY, KRISTINE L (PSYD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
Last Name:GAZLAY
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 1:40 G ST SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-4301
Mailing Address - Country:US
Mailing Address - Phone:202-455-5526
Mailing Address - Fax:
Practice Address - Street 1:1325 QUINCY ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2615
Practice Address - Country:US
Practice Address - Phone:202-455-5526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2013-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1000767103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist