Provider Demographics
NPI:1417753013
Name:GABRIELE, AVA L
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:L
Last Name:GABRIELE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 WEST ST UNIT 2330
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-1862
Mailing Address - Country:US
Mailing Address - Phone:203-525-6449
Mailing Address - Fax:
Practice Address - Street 1:95 WEST ST UNIT 2330
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1862
Practice Address - Country:US
Practice Address - Phone:203-525-6449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool