Provider Demographics
NPI:1760244065
Name:WOOD, GABRIELLE MAIRE
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MAIRE
Last Name:WOOD
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 1:1986 CASTILLO DR SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8651
Mailing Address - Country:US
Mailing Address - Phone:505-252-4789
Mailing Address - Fax:
Practice Address - Street 1:1986 CASTILLO DR SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8651
Practice Address - Country:US
Practice Address - Phone:505-252-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician