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Provider Information for 1104386416


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GAIL MAHECHA LCSW


Sex: Female

NPI: 1104386416
Last Updated: 2023-12-13
Certification Date: 2023-12-13

Details

NameValue
NPI1104386416
Enumeration Date2019-03-22
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 75 CRYSTAL RUN RD STE 201
MIDDLETOWN, NY 10941-7010
United States

Phone: 845-692-4391 | Fax:
 
Primary Practice Address 75 CRYSTAL RUN RD STE 201
MIDDLETOWN, NY 10941-7010
United States

Phone: 845-692-4391 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalNY096216-01