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General NPI Number Information
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NPI Number | 1831981612
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Entity Type | Individual
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Provider Name | GABRIELA VIVIAN MEMBA PHD
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Gender | Female
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 6833 4TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20012-1901
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Country | US
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Telephone | 202-729-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 W CULLERTON ST APT 1
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City | CHICAGO
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State | IL
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Zip | 60608-5452
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Country | US
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Telephone | 215-460-1915
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 7771344
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License Number State | ID
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