Provider Demographics
NPI:1700481785
Name:GABANA, NICOLE (PHD, CMPC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:GABANA
Suffix:
Gender:F
Credentials:PHD, CMPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GROVE ST APT C
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-8105
Mailing Address - Country:US
Mailing Address - Phone:570-460-6140
Mailing Address - Fax:
Practice Address - Street 1:15 GROVE ST APT C
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-8105
Practice Address - Country:US
Practice Address - Phone:570-460-6140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10768103TE1100X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports