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General NPI Number Information
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NPI Number | 1689564106
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Entity Type | Individual
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Provider Name | GABRIELLE M SMITH LBS1 PEL LSW
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Gender | Female
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 391 NORTH AVE
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City | ANTIOCH
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State | IL
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Zip | 60002-3204
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Country | US
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Telephone | 224-508-6655
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Fax |
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Provider Business Mailing Address
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Address Line | 4803 DAVID ST
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City | MCHENRY
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State | IL
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Zip | 60051-7966
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Country | US
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Telephone | 847-987-0372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 150117003
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License Number State |
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