Provider Demographics
NPI:1841822368
Name:MCGOWAN, GABRIEL JEROME (LCSW)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:JEROME
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3426
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90632-3426
Mailing Address - Country:US
Mailing Address - Phone:818-450-6283
Mailing Address - Fax:
Practice Address - Street 1:236 E 58TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5316
Practice Address - Country:US
Practice Address - Phone:323-238-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW874261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical