Provider Demographics
NPI:1922459478
Name:HUDSON, GABRIELLE LORRAINE (MSW)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:LORRAINE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:LORRAINE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1319 CYPRESS AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-1269
Mailing Address - Country:US
Mailing Address - Phone:424-338-8672
Mailing Address - Fax:243-388-9624
Practice Address - Street 1:1680 E 120TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3026
Practice Address - Country:US
Practice Address - Phone:424-338-8672
Practice Address - Fax:424-338-8962
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW90242104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker