Provider Demographics
NPI:1962900795
Name:REMOLE, GABRIELLE DAWN RIVETTE (LCSW)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:DAWN RIVETTE
Last Name:REMOLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:DAWN
Other - Last Name:RIVETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:15201 N 1100 EAST RD
Mailing Address - Street 2:
Mailing Address - City:CATLIN
Mailing Address - State:IL
Mailing Address - Zip Code:61817-9253
Mailing Address - Country:US
Mailing Address - Phone:310-463-6382
Mailing Address - Fax:
Practice Address - Street 1:7757 US ROUTE 136
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:IL
Practice Address - Zip Code:61865-3047
Practice Address - Country:US
Practice Address - Phone:217-799-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0197941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical