Healthcare Provider Details

I. General information

NPI: 1215676689
Provider Name (Legal Business Name): GABRIELLA M CUMMINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SHARRON AVE
PLATTSBURGH NY
12901-4700
US

IV. Provider business mailing address

15 TREMBLAY AVE
PLATTSBURGH NY
12901-2520
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-1447
  • Fax: 518-562-8812
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: