Healthcare Provider Details

I. General information

NPI: 1063893709
Provider Name (Legal Business Name): GABRIELLA LEAL LPC, LCDC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MADISON AVE FL 2
NEW YORK NY
10010-1600
US

IV. Provider business mailing address

60 MADISON AVE FL 2
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 855-629-0554
  • Fax:
Mailing address:
  • Phone: 855-629-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12726
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number76087
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: