Provider Demographics
NPI:1215683792
Name:SANROMAN, GABRIELLE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:SANROMAN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1507
Mailing Address - Country:US
Mailing Address - Phone:862-596-5218
Mailing Address - Fax:
Practice Address - Street 1:19 LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1507
Practice Address - Country:US
Practice Address - Phone:862-596-5218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01039100101YM0800X, 101YP2500X
NJ37AC00620100101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor