Provider Demographics
NPI:1295473098
Name:GORDON, GABRIELLE
Entity type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GABRIELLE
Other - Middle Name:
Other - Last Name:DILAURO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:246 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-9545
Mailing Address - Country:US
Mailing Address - Phone:732-966-2141
Mailing Address - Fax:
Practice Address - Street 1:246 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-9545
Practice Address - Country:US
Practice Address - Phone:732-966-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst