Provider Demographics
NPI:1629197090
Name:GAVRIEL, ZACHARAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARAY
Middle Name:
Last Name:GAVRIEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 SALLY CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-5442
Mailing Address - Country:US
Mailing Address - Phone:510-538-4205
Mailing Address - Fax:
Practice Address - Street 1:2946 BROADWAY
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1510
Practice Address - Country:US
Practice Address - Phone:650-299-0672
Practice Address - Fax:650-299-0677
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical