Provider Demographics
NPI:1891891719
Name:GABRIEL, NICOLE L (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6B BARRY AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4424
Mailing Address - Country:US
Mailing Address - Phone:484-437-6693
Mailing Address - Fax:
Practice Address - Street 1:4 WHITNEY STREET EXT
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3768
Practice Address - Country:US
Practice Address - Phone:203-810-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003148103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical