Provider Demographics
NPI:1518969443
Name:ZAMORA-AHLSTROM, GABRIELA (MSW)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:ZAMORA-AHLSTROM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:
Other - Last Name:ZAMORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:53375 WHITBY WAY
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-2751
Mailing Address - Country:US
Mailing Address - Phone:586-291-7557
Mailing Address - Fax:248-266-6895
Practice Address - Street 1:53375 WHITBY WAY
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-2751
Practice Address - Country:US
Practice Address - Phone:586-291-7557
Practice Address - Fax:248-266-6895
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801073863104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN13630011Medicare ID - Type Unspecified