Healthcare Provider Details

I. General information

NPI: 1710965884
Provider Name (Legal Business Name): MARILYN GILBERT GABRIEL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 WOODCHUCK HILL ROAD
GRAFTON VT
05146-0223
US

IV. Provider business mailing address

PO BOX 223
GRAFTON VT
05146-0223
US

V. Phone/Fax

Practice location:
  • Phone: 802-843-2322
  • Fax:
Mailing address:
  • Phone: 802-843-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: