Provider Demographics
NPI:1548345986
Name:VODOPIJA, GAIL A (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:A
Last Name:VODOPIJA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:GAIL
Other - Middle Name:A
Other - Last Name:PARIETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 CEDARHURST AVE
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2907
Mailing Address - Country:US
Mailing Address - Phone:631-721-7422
Mailing Address - Fax:631-803-0394
Practice Address - Street 1:755 WAVERLY AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1190
Practice Address - Country:US
Practice Address - Phone:631-721-7422
Practice Address - Fax:631-803-0394
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-071721-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN6X392OtherEMPIRE BLUE CROSS BLUE SHIELD
NY484932OtherVALUE OPTIONS
NY484932OtherVALUE OPTIONS