Provider Demographics
NPI:1912445529
Name:GANGL, MARY (LMHC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GANGL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4985 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2544
Mailing Address - Country:US
Mailing Address - Phone:716-839-0500
Mailing Address - Fax:716-938-0523
Practice Address - Street 1:4985 HARLEM RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2544
Practice Address - Country:US
Practice Address - Phone:716-839-0500
Practice Address - Fax:716-938-0523
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health