Provider Demographics
NPI:1205693645
Name:SLABODA, GABRIEL LUKE (LMSW)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:LUKE
Last Name:SLABODA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:LUKE
Other - Middle Name:
Other - Last Name:SLABODA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:166 N 7TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2931
Mailing Address - Country:US
Mailing Address - Phone:706-207-2297
Mailing Address - Fax:
Practice Address - Street 1:3 E EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5145
Practice Address - Country:US
Practice Address - Phone:347-460-4461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114947104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker