Provider Demographics
NPI:1811992431
Name:KORRICK, GAIL HELENE (MSSS / LCSW)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:HELENE
Last Name:KORRICK
Suffix:
Gender:F
Credentials:MSSS / LCSW
Other - Prefix:MISS
Other - First Name:GAIL
Other - Middle Name:HELENE
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSS / LCSW
Mailing Address - Street 1:111 PARK ST
Mailing Address - Street 2:STE 1L
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5472
Mailing Address - Country:US
Mailing Address - Phone:203-776-8673
Mailing Address - Fax:203-787-6677
Practice Address - Street 1:111 PARK ST
Practice Address - Street 2:STE 1L
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5472
Practice Address - Country:US
Practice Address - Phone:203-776-8673
Practice Address - Fax:203-787-6677
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140000038CT-01OtherANTHEM BC/BS
CT004178259-00OtherANTHEM BC/BS
CT140000038CT-01OtherANTHEM BC/BS