Provider Demographics
NPI:1023720547
Name:GAJDA, FELICE B (LMFT)
Entity type:Individual
Prefix:
First Name:FELICE
Middle Name:B
Last Name:GAJDA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:GAJDA
Other - Last Name:MAIOLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:321 W 88TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2236
Mailing Address - Country:US
Mailing Address - Phone:917-686-5990
Mailing Address - Fax:
Practice Address - Street 1:321 W 88TH ST APT B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2236
Practice Address - Country:US
Practice Address - Phone:917-686-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002044106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist