Provider Demographics
NPI:1740051036
Name:SLOAN, GABRIEL ROSS (LSW)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:ROSS
Last Name:SLOAN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2112
Mailing Address - Country:US
Mailing Address - Phone:973-761-0503
Mailing Address - Fax:
Practice Address - Street 1:102 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2112
Practice Address - Country:US
Practice Address - Phone:973-762-6909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07074400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker