Healthcare Provider Details

I. General information

NPI: 1205771599
Provider Name (Legal Business Name): GABRIELLE MARIA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 BRISTOL WAY
BUSHKILL PA
18324-7810
US

IV. Provider business mailing address

253 BRISTOL WAY
BUSHKILL PA
18324-7810
US

V. Phone/Fax

Practice location:
  • Phone: 862-296-8176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAMF000121
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: