Healthcare Provider Details

I. General information

NPI: 1124328158
Provider Name (Legal Business Name): GABRIELLE JOY DWORKIN LMHC, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON ST
TAUNTON MA
02780-3960
US

IV. Provider business mailing address

1 WASHINGTON ST
TAUNTON MA
02780-3960
US

V. Phone/Fax

Practice location:
  • Phone: 508-828-9116
  • Fax:
Mailing address:
  • Phone: 508-828-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00570
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number419331101
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number64997
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: