Provider Demographics
NPI:1073762316
Name:KYRIAKIDES, GABRIELLE SUZAN (MED)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:SUZAN
Last Name:KYRIAKIDES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4260
Mailing Address - Country:US
Mailing Address - Phone:860-989-7939
Mailing Address - Fax:
Practice Address - Street 1:309 W ELM ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4260
Practice Address - Country:US
Practice Address - Phone:860-989-7939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA408934101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor