Provider Demographics
NPI:1952091027
Name:CERCHIORI, GABRIEL GERARD
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:GERARD
Last Name:CERCHIORI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 OAKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4097
Mailing Address - Country:US
Mailing Address - Phone:231-335-3116
Mailing Address - Fax:
Practice Address - Street 1:865 OAKRIDGE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4097
Practice Address - Country:US
Practice Address - Phone:231-335-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MI4151001148106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator