Provider Demographics
NPI:1871515189
Name:CHASE, GAIL J (LCSW)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:J
Last Name:CHASE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18919 NORDHOFF ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3726
Mailing Address - Country:US
Mailing Address - Phone:818-349-7554
Mailing Address - Fax:818-349-7566
Practice Address - Street 1:18919 NORDHOFF ST
Practice Address - Street 2:SUITE #4
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3726
Practice Address - Country:US
Practice Address - Phone:818-349-7554
Practice Address - Fax:818-349-7566
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW79431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW7943Medicare ID - Type Unspecified