Provider Demographics
NPI:1962589507
Name:GABRIEL, MARSHA T (PHD)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:T
Last Name:GABRIEL
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:PO BOX 99213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0213
Mailing Address - Country:US
Mailing Address - Phone:682-885-4871
Mailing Address - Fax:682-885-3639
Practice Address - Street 1:1521 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2711
Practice Address - Country:US
Practice Address - Phone:682-885-7450
Practice Address - Fax:682-885-3308
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24410103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10033952OtherAMERIGROUP PIN
TX165127501Medicaid
TX82158POtherBCBSTX IND PIN
TX79890OtherUBH PIN
TX124201OtherSUPERIOR PIN