Healthcare Provider Details

I. General information

NPI: 1033657366
Provider Name (Legal Business Name): GABRIEL SAYRE MAECK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 OLD CORNWALLIS RD SUITE 200
DURHAM NC
27713-1869
US

IV. Provider business mailing address

2511 OLD CORNWALLIS RD SUITE 200
DURHAM NC
27713-1869
US

V. Phone/Fax

Practice location:
  • Phone: 617-549-9526
  • Fax:
Mailing address:
  • Phone: 617-549-9526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC010615
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: