Provider Demographics
NPI:1801574355
Name:FABRIKANT, GAIL LESLIE (LCSW)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:LESLIE
Last Name:FABRIKANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:LESLIE
Other - Last Name:FABRIKANT-MATSIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:100 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1900
Mailing Address - Country:US
Mailing Address - Phone:201-207-9711
Mailing Address - Fax:
Practice Address - Street 1:100 MARKET ST
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1900
Practice Address - Country:US
Practice Address - Phone:201-207-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043023001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical