Provider Demographics
NPI:1255088225
Name:WANSKER-KIRSH, GABRIELA (LCPC-C, NCC)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:WANSKER-KIRSH
Suffix:
Gender:F
Credentials:LCPC-C, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:ME
Mailing Address - Zip Code:04236-0539
Mailing Address - Country:US
Mailing Address - Phone:207-946-5444
Mailing Address - Fax:207-946-2544
Practice Address - Street 1:344 ROUTE 202
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:ME
Practice Address - Zip Code:04236-4208
Practice Address - Country:US
Practice Address - Phone:207-946-5444
Practice Address - Fax:207-946-2544
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL6585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional