Healthcare Provider Details

I. General information

NPI: 1063399624
Provider Name (Legal Business Name): GABRIELLE CIMINERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 W 25TH ST FL 11
NEW YORK NY
10001-7405
US

IV. Provider business mailing address

2930 ROCKAWAY AVE UNIT 273
OCEANSIDE NY
11572-1854
US

V. Phone/Fax

Practice location:
  • Phone: 917-605-2120
  • Fax:
Mailing address:
  • Phone: 856-472-0884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number028507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: