Provider Demographics
NPI:1902132137
Name:HATHAWAY, GABRIELLE (MS, IBCLC, PMH-C)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:MS, IBCLC, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 OAK DR
Mailing Address - Street 2:
Mailing Address - City:WEST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01585-2807
Mailing Address - Country:US
Mailing Address - Phone:508-237-8786
Mailing Address - Fax:
Practice Address - Street 1:53 OAK DR
Practice Address - Street 2:
Practice Address - City:WEST BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01585-2807
Practice Address - Country:US
Practice Address - Phone:508-237-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA108-97905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist