Provider Demographics
NPI:1689387987
Name:AMERBACH, GABRIELLA SIMONE
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:SIMONE
Last Name:AMERBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 JOHN LN
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2023
Mailing Address - Country:US
Mailing Address - Phone:631-294-7289
Mailing Address - Fax:
Practice Address - Street 1:69 JOHN LN
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2023
Practice Address - Country:US
Practice Address - Phone:631-294-7289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist