Provider Demographics
NPI:1568845931
Name:GEBOFF, ALANA SAMANTHA
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:SAMANTHA
Last Name:GEBOFF
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 1:118 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5465
Mailing Address - Country:US
Mailing Address - Phone:321-696-9599
Mailing Address - Fax:
Practice Address - Street 1:118 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5465
Practice Address - Country:US
Practice Address - Phone:321-696-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-03
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221302104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker