Provider Demographics
NPI:1669017299
Name:GABRIEL, AGATHE ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AGATHE
Middle Name:ANN
Last Name:GABRIEL
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 1:30007 N WAUKEGAN RD APT 117
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1033
Mailing Address - Country:US
Mailing Address - Phone:404-904-9498
Mailing Address - Fax:
Practice Address - Street 1:400 CENTRAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3024
Practice Address - Country:US
Practice Address - Phone:847-579-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0214011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical