Provider Demographics
NPI:1649303686
Name:GABLIANI, VERA IRENE (PHD)
Entity type:Individual
Prefix:DR
First Name:VERA
Middle Name:IRENE
Last Name:GABLIANI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 MANCHESTER ROAD
Mailing Address - Street 2:SUITE #201
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1200
Mailing Address - Country:US
Mailing Address - Phone:314-966-0880
Mailing Address - Fax:
Practice Address - Street 1:10900 MANCHESTER ROAD
Practice Address - Street 2:SUITE #201
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-1200
Practice Address - Country:US
Practice Address - Phone:314-966-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2008-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01679103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO264997OtherHEALTHLINK