Provider Demographics
NPI:1598206203
Name:GABOSE, RASHAD (MSW-LGWS)
Entity Type:Individual
Prefix:MR
First Name:RASHAD
Middle Name:
Last Name:GABOSE
Suffix:
Gender:M
Credentials:MSW-LGWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1959
Mailing Address - Country:US
Mailing Address - Phone:612-332-9124
Mailing Address - Fax:612-332-9124
Practice Address - Street 1:2233 UNIVERSITY AVE W STE 357
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1698
Practice Address - Country:US
Practice Address - Phone:612-332-9124
Practice Address - Fax:612-332-9124
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22975104100000X
374U00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No374U00000XNursing Service Related ProvidersHome Health Aide