Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 1891 | OK |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 11346 | NY |
NPI | 1003037607 |
---|---|
Provider Name | Renee Gambol |
First Address | Inwood, NY 11096 |
Second Address | Far Rockaway, NY 11691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |