Provider Demographics
NPI:1659834141
Name:NIGRIEL, GABRIEL YAW (LAC)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:YAW
Last Name:NIGRIEL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2509
Mailing Address - Country:US
Mailing Address - Phone:862-266-8267
Mailing Address - Fax:
Practice Address - Street 1:260 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2509
Practice Address - Country:US
Practice Address - Phone:862-266-8267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00397800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty