Provider Demographics
NPI:1942864376
Name:GABRIEL, TRINA (LSW)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 VILLA EAST DR # 2
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:44077-6902
Mailing Address - Country:US
Mailing Address - Phone:440-444-2508
Mailing Address - Fax:
Practice Address - Street 1:404 VILLA EAST DR # 2
Practice Address - Street 2:
Practice Address - City:FAIRPORT HARBOR
Practice Address - State:OH
Practice Address - Zip Code:44077-6902
Practice Address - Country:US
Practice Address - Phone:440-444-2508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1600577104100000X
172A00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No172A00000XOther Service ProvidersDriver