Healthcare Provider Details

I. General information

NPI: 1255106837
Provider Name (Legal Business Name): GABRIELLE AQUILA RICHARDS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2023
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 GRAND AVE
BALDWIN NY
11510-3148
US

IV. Provider business mailing address

60 E ROGUES PATH
HUNTINGTON STATION NY
11746-2750
US

V. Phone/Fax

Practice location:
  • Phone: 516-377-5400
  • Fax: 516-377-5490
Mailing address:
  • Phone: 347-394-9153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: