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NPI Code Detail

MEDICARE: GABRIELLE BRISSON

MEDICARE: GABRIELLE BRISSON
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
1104100000XSocial Worker
2104100000XSocial Worker104486-01NY

General Provider Information

NPI Number : 1811479603
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIELLE BRISSON
Provider Business Mailing Address
First Line : 145 W 15TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10011-6701
Country : US
Telephone Number : 212-924-6320
Fax Number : 212-691-5635
Provider Business Practice Location Address
First Line : 28 DEBEVOISE ST STE 5
Second Line :
City : BROOKLYN
State : NY
Zip : 11206-4194
Country : US
Telephone Number : 646-459-6091
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2018
Last Update Date : 04/29/2021

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