Healthcare Provider Details

I. General information

NPI: 1548792773
Provider Name (Legal Business Name): GABRIELA FOSTER-MARTIN LMSW, CSW-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6629 TUMBLEWEED RIDGE LN UNIT 103
HENDERSON NV
89011-1465
US

IV. Provider business mailing address

6629 TUMBLEWEED RIDGE LN UNIT 103
HENDERSON NV
89011-1465
US

V. Phone/Fax

Practice location:
  • Phone: 702-530-1432
  • Fax:
Mailing address:
  • Phone: 702-530-1432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberIC-2516
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number89115
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: