Provider Demographics
NPI:1164977302
Name:KANN, GABRIELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:
Last Name:KANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 EASTERN PKWY APT B6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6360
Mailing Address - Country:US
Mailing Address - Phone:929-390-2273
Mailing Address - Fax:
Practice Address - Street 1:255 EASTERN PKWY APT B6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6360
Practice Address - Country:US
Practice Address - Phone:929-390-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0937801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY093780OtherLICENSED CLINICAL SOCIAL WORK