Healthcare Provider Details

I. General information

NPI: 1124659446
Provider Name (Legal Business Name): GABRIELLE FRIEDMANN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 TEN ROD RD BLDG B201
NORTH KINGSTOWN RI
02852-5526
US

IV. Provider business mailing address

179 EASTWICK RD
NORTH KINGSTOWN RI
02852-3516
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-3990
  • Fax:
Mailing address:
  • Phone: 401-330-0981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA00205
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: