Provider Demographics
NPI:1457845604
Name:GABRIEL, JON MICKEL (LCSW)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:MICKEL
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 1:2736 DAILY DR
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-8072
Mailing Address - Country:US
Mailing Address - Phone:714-614-4887
Mailing Address - Fax:
Practice Address - Street 1:2736 DAILY DR
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-8072
Practice Address - Country:US
Practice Address - Phone:714-614-4887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA1188951041C0700X
HILCSW-48781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker