Healthcare Provider Details

I. General information

NPI: 1053929570
Provider Name (Legal Business Name): GABRIELLE MARIE CROUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 OAKS WAY APT 904
POMPANO BEACH FL
33069-5387
US

IV. Provider business mailing address

154 KING ST
WESTBROOK ME
04092-3034
US

V. Phone/Fax

Practice location:
  • Phone: 305-807-1909
  • Fax: 305-397-0308
Mailing address:
  • Phone: 207-318-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: