Provider Demographics
NPI:1457832925
Name:DEFORD, GABRIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:DEFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 AVON ST # 3
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2423
Mailing Address - Country:US
Mailing Address - Phone:203-742-0006
Mailing Address - Fax:
Practice Address - Street 1:92 AVON ST # 3
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2423
Practice Address - Country:US
Practice Address - Phone:203-742-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0114191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical