Provider Demographics
NPI:1538636816
Name:MARKS, GABRIELLA ANN
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:ANN
Last Name:MARKS
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 1:8701 FENWICK HILL PL APT D
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5846
Mailing Address - Country:US
Mailing Address - Phone:502-544-9839
Mailing Address - Fax:
Practice Address - Street 1:2210 GOLDSMITH LN STE 266
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1038
Practice Address - Country:US
Practice Address - Phone:502-618-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2536571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical