Provider Demographics
NPI:1538260914
Name:LABELLA, GARY MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:MICHAEL
Last Name:LABELLA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CLIFTON COUNTRY RD
Mailing Address - Street 2:(SUITE 206)
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3838
Mailing Address - Country:US
Mailing Address - Phone:518-371-7202
Mailing Address - Fax:518-373-6686
Practice Address - Street 1:56 CLIFTON COUNTRY RD
Practice Address - Street 2:(SUITE 206)
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3838
Practice Address - Country:US
Practice Address - Phone:518-371-7202
Practice Address - Fax:518-373-6686
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-28435-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56147BMedicare ID - Type UnspecifiedSOCIAL WORK