Healthcare Provider Details

I. General information

NPI: 1780259259
Provider Name (Legal Business Name): GABRIELLE CARPENTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 3RD AVE SW STE 7
CARMEL IN
46032-7500
US

IV. Provider business mailing address

1389 W 86TH ST # 170
INDIANAPOLIS IN
46260-2101
US

V. Phone/Fax

Practice location:
  • Phone: 317-564-0934
  • Fax:
Mailing address:
  • Phone: 317-409-6151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-93849
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: