Healthcare Provider Details

I. General information

NPI: 1417882945
Provider Name (Legal Business Name): GABRIELLE R MARTINEAU DE FARIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 KENNEDY MEMORIAL DR
OAKLAND ME
04963-4887
US

IV. Provider business mailing address

77 CLINTON AVE APT 204
WINSLOW ME
04901-7015
US

V. Phone/Fax

Practice location:
  • Phone: 207-716-1843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: