Provider Demographics
NPI:1194263632
Name:GABRIELLE P. HACKETT, PSY.D., LLC
Entity type:Organization
Organization Name:GABRIELLE P. HACKETT, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-812-3482
Mailing Address - Street 1:18601 TRANQUILITY BASE LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-3236
Mailing Address - Country:US
Mailing Address - Phone:954-812-3482
Mailing Address - Fax:954-900-1197
Practice Address - Street 1:1575 INDIAN RIVER BLVD STE C225
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7127
Practice Address - Country:US
Practice Address - Phone:954-812-3482
Practice Address - Fax:954-900-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-04
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty