Provider Demographics
NPI:1316154289
Name:GIBREEL, TAMADOR S
Entity type:Individual
Prefix:
First Name:TAMADOR
Middle Name:S
Last Name:GIBREEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LENOX STREET
Mailing Address - Street 2:JEWISH FAMILY SERVICES
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108
Mailing Address - Country:US
Mailing Address - Phone:413-746-2001
Mailing Address - Fax:413-746-2024
Practice Address - Street 1:15 LENOX STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108
Practice Address - Country:US
Practice Address - Phone:413-746-2001
Practice Address - Fax:413-746-2024
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health