Provider Demographics
NPI:1467756494
Name:FEDORKO, GABRIELLE CATHERINE (BS)
Entity Type:Individual
Prefix:MISS
First Name:GABRIELLE
Middle Name:CATHERINE
Last Name:FEDORKO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 FIELDSTONE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SUMMERHILL
Mailing Address - State:PA
Mailing Address - Zip Code:15958-7900
Mailing Address - Country:US
Mailing Address - Phone:814-244-7445
Mailing Address - Fax:
Practice Address - Street 1:1962 FIELDSTONE AVE
Practice Address - Street 2:
Practice Address - City:SUMMERHILL
Practice Address - State:PA
Practice Address - Zip Code:15958-3902
Practice Address - Country:US
Practice Address - Phone:814-244-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor