Healthcare Provider Details

I. General information

NPI: 1669147732
Provider Name (Legal Business Name): GABRIELA BROCKETT PHD, LCMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELA BARBER PHD, LCMFT

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 COURT ST STE 210
EXETER NH
03833-2745
US

IV. Provider business mailing address

5654 SHIELDS DR
BETHESDA MD
20817-3574
US

V. Phone/Fax

Practice location:
  • Phone: 603-242-2296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM944
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number330
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT200001342
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: