Provider Demographics
NPI:1801537261
Name:TAVAREZ, GABRIELLA JANAY (LCSW)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:JANAY
Last Name:TAVAREZ
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 1:31 E MUNSELL AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-3115
Mailing Address - Country:US
Mailing Address - Phone:908-487-0763
Mailing Address - Fax:
Practice Address - Street 1:31 E MUNSELL AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-3115
Practice Address - Country:US
Practice Address - Phone:908-487-0763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06771200104100000X
NJ44SC064697001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker