Provider Demographics
NPI:1669147732
Name:BROCKETT, GABRIELA (PHD, LCMFT)
Entity type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:
Last Name:BROCKETT
Suffix:
Gender:F
Credentials:PHD, LCMFT
Other - Prefix:DR
Other - First Name:GABRIELA
Other - Middle Name:
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LCMFT
Mailing Address - Street 1:5654 SHIELDS DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-3574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 COURT ST STE 210
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2745
Practice Address - Country:US
Practice Address - Phone:603-242-2296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM944106H00000X
NH330106H00000X
DCLMFT200001342106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist