Provider Demographics
NPI:1659452696
Name:GABOSCH, JEANNETTE (RCSW)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:GABOSCH
Suffix:
Gender:F
Credentials:RCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 WALDEN CT
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-1817
Mailing Address - Country:US
Mailing Address - Phone:631-736-4997
Mailing Address - Fax:
Practice Address - Street 1:193 WALDEN CT
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-1817
Practice Address - Country:US
Practice Address - Phone:631-736-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0280561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN76621Medicare ID - Type Unspecified