Healthcare Provider Details

I. General information

NPI: 1518821321
Provider Name (Legal Business Name): GABRIELLE BRYN DUBOFF BSN RN, PMH-BC, CPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 N DAYTON ST STE 2440
CHICAGO IL
60642-2644
US

IV. Provider business mailing address

1440 N DAYTON ST STE 2440
CHICAGO IL
60642-2644
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-0681
  • Fax: 312-227-9269
Mailing address:
  • Phone: 312-227-0681
  • Fax: 312-227-9269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.424695
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number041.424695
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: