MEDICARE: MELINDA GABRIEL LICENSED MARRIAGE AN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	001335	NY
2	106H00000X	Marriage & Family Therapist		NY

General Provider Information

NPI Number	:	1578928339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA GABRIEL LICENSED MARRIAGE AN

Provider Business Mailing Address
First Line	:	611 WEST MAIN STREET
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-1336
Country	:	US
Telephone Number	:	315-788-1530
Fax Number	:	315-755-2538

Provider Business Practice Location Address
First Line	:	611 WEST MAIN STREET
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-1336
Country	:	US
Telephone Number	:	315-788-1530
Fax Number	:	315-755-2538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2015
Last Update Date	:	12/03/2025

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