Individual
MAXINE C. GAYLORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W, BCD
Contact information
Practice address
75 MAIDEN LN, SUITE # 215, NEW YORK, NY 10038-4810
(917) 399-9117
Mailing address
411 W END AVE, #19B, NEW YORK, NY 10024-5719
(917) 399-9117
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PR-026241
LICENSSED CLINICAL SOCIAL WORKER
NY
Enumeration date
01/15/2011
Last updated
01/15/2011
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