Provider Demographics
NPI:1275129355
Name:MELTZER, GABRIELLE SARAH
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:SARAH
Last Name:MELTZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5509
Mailing Address - Country:US
Mailing Address - Phone:415-459-8252
Mailing Address - Fax:
Practice Address - Street 1:6214 RIVERDALE AVE STE 1A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1032
Practice Address - Country:US
Practice Address - Phone:718-701-4807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111132104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker