Provider Demographics
NPI:1316170582
Name:NELSON, GABRIELA VERA (PSYD)
Entity type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:VERA
Last Name:NELSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 FRANKLIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1222
Mailing Address - Country:US
Mailing Address - Phone:917-846-0053
Mailing Address - Fax:718-559-4792
Practice Address - Street 1:393 FRANKLIN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-1222
Practice Address - Country:US
Practice Address - Phone:917-846-0053
Practice Address - Fax:718-559-4792
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018242103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist