Provider Information for 1235616889
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Ms. GABRIELLA R LAKE LCSW
Sex: Female
NPI: 1235616889
Last Updated: 2024-03-08
Certification Date: 2024-03-08
Certification Date: 2024-03-08
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1235616889 | ||||||||||||
| Enumeration Date | 2018-07-26 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 57 W BURNSIDE AVE # B1 BRONX, NY 10453-4038 United States Phone: 718-893-8900 | Fax: | ||||||||||||
| Primary Practice Address | 57 W BURNSIDE AVE # B1 BRONX, NY 10453-4038 United States Phone: 718-893-8900 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 57 W BURNSIDE AVE # B1 | ||||||||||||
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