Provider Demographics
NPI:1720637853
Name:DARIENZO, GABRIELLE
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:
Last Name:DARIENZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GLORIA DR
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1111
Mailing Address - Country:US
Mailing Address - Phone:973-216-0903
Mailing Address - Fax:
Practice Address - Street 1:28 BLOOMFIELD AVE STE 204
Practice Address - Street 2:
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9903
Practice Address - Country:US
Practice Address - Phone:973-244-2448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00912000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist