MEDICARE: GABRIELLA ANTONIELLO LSW

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	104100000X	Social Worker	44SL06572300	NJ

General Provider Information

NPI Number	:	1992318471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLA ANTONIELLO LSW

Provider Business Mailing Address
First Line	:	611 US HIGHWAY 46 W
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-3120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 US HIGHWAY 46 W
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-3120
Country	:	US
Telephone Number	:	201-478-4162
Fax Number	:

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

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/25/2020

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