Provider Demographics
NPI:1356650402
Name:ROEMER, GABRIELLA LAUREN
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLA
Middle Name:LAUREN
Last Name:ROEMER
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 1:23461 S POINTE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1547
Mailing Address - Country:US
Mailing Address - Phone:949-855-1556
Mailing Address - Fax:
Practice Address - Street 1:980 CATALINA
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2748
Practice Address - Country:US
Practice Address - Phone:949-494-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2016-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF71124106H00000X
CALMFT93116106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist