Provider Demographics
NPI:1427319318
Name:GABRIEL, MARJORIE (MSED/ BCBA)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:MSED/ BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 PUTNEY RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1818
Mailing Address - Country:US
Mailing Address - Phone:347-564-3275
Mailing Address - Fax:516-823-3363
Practice Address - Street 1:1626 PUTNEY RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1818
Practice Address - Country:US
Practice Address - Phone:347-564-3275
Practice Address - Fax:516-823-3363
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-09-6470103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst