Provider Demographics
NPI:1477204766
Name:DEGIORGIO, GABRIELLE ELIZABETH
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ELIZABETH
Last Name:DEGIORGIO
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 1:1400 CRESCENT VISCHER FERRY RD APT 103
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-7929
Mailing Address - Country:US
Mailing Address - Phone:518-860-7170
Mailing Address - Fax:
Practice Address - Street 1:713 TROY SCHENECTADY RD STE 224
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2490
Practice Address - Country:US
Practice Address - Phone:518-782-3976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health