Healthcare Provider Details

I. General information

NPI: 1174270714
Provider Name (Legal Business Name): GABRIELLE ANNA PADEREWSKI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/27/2022
Certification Date: 03/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5102 PAULSEN ST BLDG 8
SAVANNAH GA
31405-4624
US

IV. Provider business mailing address

425 HUNT DR
SAVANNAH GA
31406-8956
US

V. Phone/Fax

Practice location:
  • Phone: 912-655-8855
  • Fax: 912-335-6571
Mailing address:
  • Phone: 912-667-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMSW010546
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: