Healthcare Provider Details

I. General information

NPI: 1992523443
Provider Name (Legal Business Name): GABRIELLA JAE CISNEROS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SALISBURY AVE
STEWART MANOR NY
11530-3830
US

IV. Provider business mailing address

1 SALISBURY AVE
STEWART MANOR NY
11530-3830
US

V. Phone/Fax

Practice location:
  • Phone: 917-543-1901
  • Fax:
Mailing address:
  • Phone: 917-543-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number124934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: