Provider Demographics
NPI:1538643713
Name:GABBERT, MARY (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GABBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 NEAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0944
Mailing Address - Country:US
Mailing Address - Phone:193-152-0152
Mailing Address - Fax:931-223-0106
Practice Address - Street 1:1080 NEAL ST STE 200
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0944
Practice Address - Country:US
Practice Address - Phone:193-152-0152
Practice Address - Fax:931-223-0106
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW067461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical