Provider Demographics
NPI:1952977951
Name:WACHS, GABRIELLA (MSS, LSW)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:WACHS
Suffix:
Gender:F
Credentials:MSS, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-2013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AHAD HAAM STREET 23B
Practice Address - Street 2:ISRAEL
Practice Address - City:JERUSALEM
Practice Address - State:ISRAEL
Practice Address - Zip Code:9215125
Practice Address - Country:IL
Practice Address - Phone:058-664-7267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1362571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical