Provider Demographics
NPI:1306085493
Name:ANDERSON, GABRIELLE ELIZA (PHD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:ELIZA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MARKET ST
Mailing Address - Street 2:SUITE 2200-HALLOWELL CENTER
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-2422
Mailing Address - Country:US
Mailing Address - Phone:917-239-1081
Mailing Address - Fax:
Practice Address - Street 1:425 MARKET ST
Practice Address - Street 2:SUITE 2200-HALLOWELL CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-2422
Practice Address - Country:US
Practice Address - Phone:917-239-1081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017003-1103T00000X, 103TC0700X, 103TC2200X
CAPSY25456103T00000X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent