Healthcare Provider Details

I. General information

NPI: 1083523740
Provider Name (Legal Business Name): GABRIEL THOMPSON PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGH ST STE 3B
PORTLAND ME
04101-7803
US

IV. Provider business mailing address

200 HIGH ST STE 3B
PORTLAND ME
04101-7803
US

V. Phone/Fax

Practice location:
  • Phone: 617-299-0128
  • Fax:
Mailing address:
  • Phone: 617-299-0128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: GABRIEL THOMPSON
Title or Position: CLINICAL MENTAL HEALTH COUNSELOR
Credential:
Phone: 617-299-0128