Provider Demographics
NPI:1881232395
Name:DEREN, GABRIELLA JENNIFER
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:JENNIFER
Last Name:DEREN
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 1:21 COVE LN APT 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6067
Mailing Address - Country:US
Mailing Address - Phone:347-645-6600
Mailing Address - Fax:
Practice Address - Street 1:308 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6845
Practice Address - Country:US
Practice Address - Phone:347-728-6771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical