Provider Demographics
NPI:1578970786
Name:BROOKS-HARRIS, GABRIEL (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:BROOKS-HARRIS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MONTIETH ST APT 324
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4692
Mailing Address - Country:US
Mailing Address - Phone:781-696-5679
Mailing Address - Fax:
Practice Address - Street 1:397 BRIDGE ST FL 7
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5247
Practice Address - Country:US
Practice Address - Phone:347-765-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-20
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY672954163WP0808X
NYF401921-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health