Provider Demographics
NPI:1518318740
Name:WEISMAN, GABRIELLE (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1050
Mailing Address - Country:US
Mailing Address - Phone:973-943-3420
Mailing Address - Fax:
Practice Address - Street 1:18 MADISON AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1050
Practice Address - Country:US
Practice Address - Phone:973-943-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00218200101YA0400X
NJ44SC056514001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)