Provider Demographics
NPI:1598898884
Name:JOHR, GABRIELLA (PSYD)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:JOHR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 5TH ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3504
Mailing Address - Country:US
Mailing Address - Phone:718-768-3622
Mailing Address - Fax:718-405-5953
Practice Address - Street 1:3300 KOSSUTH AVENUE
Practice Address - Street 2:MMC - DEPT. OF CHILD PSYCHIATR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016237103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist