Provider Demographics
NPI:1710965884
Name:GABRIEL, MARILYN GILBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:GILBERT
Last Name:GABRIEL
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:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:VT
Mailing Address - Zip Code:05146-0223
Mailing Address - Country:US
Mailing Address - Phone:802-843-2322
Mailing Address - Fax:
Practice Address - Street 1:275 WOODCHUCK HILL ROAD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:VT
Practice Address - Zip Code:05146-0223
Practice Address - Country:US
Practice Address - Phone:802-843-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT5824201OtherAETNA INSURANCE COMPANY
VTOVN0059Medicaid
VT133184OtherMHN
NH30423639Medicaid
NH14Y008340VT01OtherANTHEM BC/BS OF NH
VT383795OtherMVP
VT18286OtherVT BC/BS
VT18286OtherVT BC/BS