Provider Demographics
NPI:1134340474
Name:CHERNOFF, GABRIEL IAN (LCSWC)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:IAN
Last Name:CHERNOFF
Suffix:
Gender:M
Credentials:LCSWC
Other - Prefix:
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Mailing Address - Street 1:5525 TWIN KNOLLS RD
Mailing Address - Street 2:SUITE 327
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:410-992-9149
Mailing Address - Fax:410-992-9921
Practice Address - Street 1:2915 OLNEY SANDY SPRING RD
Practice Address - Street 2:B
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1531
Practice Address - Country:US
Practice Address - Phone:301-570-7500
Practice Address - Fax:301-570-7504
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD123361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD816700100Medicaid