Provider Demographics
NPI:1417643438
Name:GABRIELLA BERGONZI COUNSELING LLC
Entity Type:Organization
Organization Name:GABRIELLA BERGONZI COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGONZI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-396-4581
Mailing Address - Street 1:7 SEAPORT DR APT 310
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1577
Mailing Address - Country:US
Mailing Address - Phone:508-717-7957
Mailing Address - Fax:
Practice Address - Street 1:7 SEAPORT DR APT 310
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1577
Practice Address - Country:US
Practice Address - Phone:508-717-7957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health