Provider Demographics
NPI:1831851732
Name:LOWELL, GABRIELLE EMMA
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:EMMA
Last Name:LOWELL
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 1:709 W BROMPTON AVE APT 71
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1841
Mailing Address - Country:US
Mailing Address - Phone:516-592-1911
Mailing Address - Fax:
Practice Address - Street 1:25406 W END DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11020-1019
Practice Address - Country:US
Practice Address - Phone:516-592-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107760104100000X
IL1490263641041C0700X
NY0958761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker