Provider Demographics
NPI:1609218700
Name:GABRIELE, SAMANTHA JO (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:GABRIELE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 E NC HIGHWAY 54
Mailing Address - Street 2:SUITE 320
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7512
Mailing Address - Country:US
Mailing Address - Phone:919-753-1080
Mailing Address - Fax:
Practice Address - Street 1:249 E NC HIGHWAY 54
Practice Address - Street 2:SUITE 320
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7512
Practice Address - Country:US
Practice Address - Phone:919-753-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0096951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical