Healthcare Provider Details

I. General information

NPI: 1730750324
Provider Name (Legal Business Name): GIANNA CLAIRE GAMBERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4778 OVERTON RD
BIRMINGHAM AL
35210-3803
US

IV. Provider business mailing address

4778 OVERTON RD
BIRMINGHAM AL
35210-3803
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12672
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2305
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: