Provider Demographics
NPI:1649676362
Name:SERRANO, GABRIEL ADAM (ASW)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ADAM
Last Name:SERRANO
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 WARING RD STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2700
Mailing Address - Country:US
Mailing Address - Phone:619-660-3886
Mailing Address - Fax:
Practice Address - Street 1:5972 KENYATTA CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-5512
Practice Address - Country:US
Practice Address - Phone:619-677-2879
Practice Address - Fax:619-660-6604
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62164101YM0800X
CA949571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health