Provider Demographics
NPI:1295890812
Name:GABRIEL, MARK S (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:LCSW
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 223
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:VT
Mailing Address - Zip Code:05146-0223
Mailing Address - Country:US
Mailing Address - Phone:802-843-2322
Mailing Address - Fax:
Practice Address - Street 1:275 WOODCHCUK HILL RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:VT
Practice Address - Zip Code:05146-0223
Practice Address - Country:US
Practice Address - Phone:802-843-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00003051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0093640OtherMHN SERVICES
VT0VN0167Medicaid
VT18285OtherBCBS