Provider Demographics
NPI:1033471784
Name:CARMODY, GABRIELLE JUDITH (MSED)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:JUDITH
Last Name:CARMODY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-2611
Mailing Address - Country:US
Mailing Address - Phone:631-772-5048
Mailing Address - Fax:
Practice Address - Street 1:82 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-2611
Practice Address - Country:US
Practice Address - Phone:631-772-5048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1295813174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist