Provider Demographics
NPI:1093924557
Name:FAGGELLA, GABRIELLE ELIZABETH (MSSA, LISW-S)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ELIZABETH
Last Name:FAGGELLA
Suffix:
Gender:F
Credentials:MSSA, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3094 W MARKET ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3626
Mailing Address - Country:US
Mailing Address - Phone:330-836-8370
Mailing Address - Fax:330-836-8373
Practice Address - Street 1:3094 W MARKET ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3626
Practice Address - Country:US
Practice Address - Phone:330-836-8370
Practice Address - Fax:330-836-8373
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00041361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical