MEDICARE: MRS. GABRIELLA MARIAH MASTRONARDI LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	009315	NY

General Provider Information

NPI Number	:	1881063980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GABRIELLA MARIAH MASTRONARDI LMHC

Provider Business Mailing Address
First Line	:	14108 JEWEL AVE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-1618
Country	:	US
Telephone Number	:	347-815-4228
Fax Number	:

Provider Business Practice Location Address
First Line	:	10209 METROPOLITAN AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6731
Country	:	US
Telephone Number	:	929-260-1033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2015
Last Update Date	:	10/18/2019

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