Provider Demographics
NPI:1114581469
Name:GABRILA, LYNETTE RENEE
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:RENEE
Last Name:GABRILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:RENEE
Other - Last Name:POOLEY-MOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-3339
Mailing Address - Country:US
Mailing Address - Phone:508-799-0688
Mailing Address - Fax:
Practice Address - Street 1:411 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3339
Practice Address - Country:US
Practice Address - Phone:508-799-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor