Provider Demographics
NPI:1477206662
Name:RIECKHOF, GABRIELLE EUGENIE (PHD, MA, LMHC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:EUGENIE
Last Name:RIECKHOF
Suffix:
Gender:F
Credentials:PHD, MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WAVERLY PL APT 3P
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6712
Mailing Address - Country:US
Mailing Address - Phone:617-685-1597
Mailing Address - Fax:
Practice Address - Street 1:23 GREEN ST STE 105
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3336
Practice Address - Country:US
Practice Address - Phone:631-301-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012060-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health