Provider Demographics
NPI:1700433075
Name:HAYWARD, GABRIELLE A (MS, LCMHC)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:A
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN SPRINGS
Mailing Address - State:VT
Mailing Address - Zip Code:05757-4297
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN SPRINGS
Practice Address - State:VT
Practice Address - Zip Code:05757-4297
Practice Address - Country:US
Practice Address - Phone:508-280-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0123818101YM0800X
VT068.0134278101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT097.0123818Medicaid
VT097.0123818OtherBCBSVT