Provider Demographics
NPI:1922551696
Name:LEON, GABRIELLA (ISW)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:ISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 ISLAND WALK WAY
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4797
Mailing Address - Country:US
Mailing Address - Phone:904-277-0027
Mailing Address - Fax:407-867-6261
Practice Address - Street 1:1903 ISLAND WALK WAY
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4797
Practice Address - Country:US
Practice Address - Phone:904-277-0027
Practice Address - Fax:407-867-6261
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 58141041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical