Provider Demographics
NPI:1134555154
Name:ETZENSBERGER, GABRIELA (MA CCC)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:ETZENSBERGER
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 E 6TH ST APT 6E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7009
Mailing Address - Country:US
Mailing Address - Phone:347-219-3374
Mailing Address - Fax:
Practice Address - Street 1:754 E 6TH ST APT 6E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-7009
Practice Address - Country:US
Practice Address - Phone:347-219-3374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist