Provider Demographics
NPI:1588012934
Name:GYABAA, EBONY Y
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:Y
Last Name:GYABAA
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 1:181 MASSASOIT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1756
Mailing Address - Country:US
Mailing Address - Phone:413-330-0415
Mailing Address - Fax:413-733-7841
Practice Address - Street 1:66 GOLD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1325
Practice Address - Country:US
Practice Address - Phone:413-330-0415
Practice Address - Fax:413-733-7841
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW11207531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical