Provider Demographics
NPI:1821985490
Name:GRANT, GABRIELLE T (LPCA)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:T
Last Name:GRANT
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CLAUDIA DR APT 434
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-3063
Mailing Address - Country:US
Mailing Address - Phone:203-214-5787
Mailing Address - Fax:
Practice Address - Street 1:410 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-5014
Practice Address - Country:US
Practice Address - Phone:203-503-3000
Practice Address - Fax:203-503-3415
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health