Provider Demographics
NPI:1578188454
Name:GERNGROSS, GABRIELLE NICHOLE (LSW)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:NICHOLE
Last Name:GERNGROSS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1720
Mailing Address - Country:US
Mailing Address - Phone:267-688-7266
Mailing Address - Fax:
Practice Address - Street 1:616 PIERCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1720
Practice Address - Country:US
Practice Address - Phone:267-688-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136255104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker