Provider Demographics
NPI:1386186377
Name:PESCE, GABRIELLA F
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:F
Last Name:PESCE
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 1:48 GLENGORIFF CIR
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-1461
Mailing Address - Country:US
Mailing Address - Phone:781-244-4134
Mailing Address - Fax:
Practice Address - Street 1:228 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1251
Practice Address - Country:US
Practice Address - Phone:781-438-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000009697101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health