Healthcare Provider Details

I. General information

NPI: 1043966013
Provider Name (Legal Business Name): GABRIELLA NELSON LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 MORRIS TPKE
SHORT HILLS NJ
07078-2625
US

IV. Provider business mailing address

445 UNION AVE APT 2H
RUTHERFORD NJ
07070-1404
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01277300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: