Provider Demographics
NPI:1992523443
Name:CISNEROS, GABRIELLA JAE (LMSW)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:JAE
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SALISBURY AVE
Mailing Address - Street 2:
Mailing Address - City:STEWART MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3830
Mailing Address - Country:US
Mailing Address - Phone:917-543-1901
Mailing Address - Fax:
Practice Address - Street 1:1 SALISBURY AVE
Practice Address - Street 2:
Practice Address - City:STEWART MANOR
Practice Address - State:NY
Practice Address - Zip Code:11530-3830
Practice Address - Country:US
Practice Address - Phone:917-543-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124934104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker