Provider Demographics
NPI:1932675030
Name:WITKIN, GABRIELLE LEIGH (MSED, MPHILED)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:LEIGH
Last Name:WITKIN
Suffix:
Gender:F
Credentials:MSED, MPHILED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 KING OF PRUSSIA RD FL 2
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4440
Mailing Address - Country:US
Mailing Address - Phone:800-736-3739
Mailing Address - Fax:610-293-7680
Practice Address - Street 1:320 KING OF PRUSSIA RD FL 2
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-4440
Practice Address - Country:US
Practice Address - Phone:800-736-3739
Practice Address - Fax:610-293-7680
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YS0200X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty