Provider Demographics
NPI:1407200645
Name:HACKETT, GABRIELLE PAIGE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:PAIGE
Last Name:HACKETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18601 TRANQUILITY BASE LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-3236
Mailing Address - Country:US
Mailing Address - Phone:954-812-3482
Mailing Address - Fax:954-900-1197
Practice Address - Street 1:1575 INDIAN RIVER BLVD STE C225
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7127
Practice Address - Country:US
Practice Address - Phone:954-812-3482
Practice Address - Fax:954-900-1197
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9507103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist