Provider Demographics
NPI:1669502290
Name:PEREIRA, GABRIELLE JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:JOAN
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 EAST JOPPA ROAD
Mailing Address - Street 2:HAMPTON HOUSE BUILDING PENTHOUSE 14A
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3118
Mailing Address - Country:US
Mailing Address - Phone:410-296-3281
Mailing Address - Fax:410-833-3914
Practice Address - Street 1:204 EAST JOPPA ROAD
Practice Address - Street 2:PENTHOUSE 14A
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3118
Practice Address - Country:US
Practice Address - Phone:410-296-3281
Practice Address - Fax:410-833-3914
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD01406103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG704OtherBCBS
MDT187OtherBCBS
MDG704Medicare ID - Type Unspecified