Provider Demographics
NPI:1568978922
Name:ANDRADE, GABRIELA LOPES
Entity Type:Individual
Prefix:MISS
First Name:GABRIELA
Middle Name:LOPES
Last Name:ANDRADE
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 1:17 RUFUS ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2728
Mailing Address - Country:US
Mailing Address - Phone:508-857-9923
Mailing Address - Fax:
Practice Address - Street 1:80 WASHINGTON STREET
Practice Address - Street 2:BUILDING P55
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061
Practice Address - Country:US
Practice Address - Phone:781-290-3886
Practice Address - Fax:781-836-5006
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty