Provider Demographics
NPI:1215759295
Name:SMITH, GABRIELLE (MA)
Entity type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:BRIELLE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:800 HERITAGE DRIVE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-9998
Mailing Address - Country:US
Mailing Address - Phone:484-447-7255
Mailing Address - Fax:
Practice Address - Street 1:800 HERITAGE DR STE 810
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-9220
Practice Address - Country:US
Practice Address - Phone:484-447-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health