Provider Demographics
NPI:1003531765
Name:CRISAFULLI, GABRIELLE (LAC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:CRISAFULLI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1808
Mailing Address - Country:US
Mailing Address - Phone:973-444-3423
Mailing Address - Fax:
Practice Address - Street 1:306 WASHINGTON ST # 302
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5162
Practice Address - Country:US
Practice Address - Phone:201-218-7431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00955600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health