Provider Demographics
NPI:1447352091
Name:GABRIEL, KELLY ELIZABETH (LMSW , CAADC)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ELIZABETH
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:LMSW , CAADC
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:932 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1442
Mailing Address - Country:US
Mailing Address - Phone:586-770-7090
Mailing Address - Fax:
Practice Address - Street 1:932 HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1442
Practice Address - Country:US
Practice Address - Phone:586-770-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010695191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM97240019Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION