Provider Demographics
NPI:1861171191
Name:AUGUSTAMAR, GABRIELLE MARIE IONE
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MARIE IONE
Last Name:AUGUSTAMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 SW JUNEAU ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1621
Mailing Address - Country:US
Mailing Address - Phone:206-207-5395
Mailing Address - Fax:
Practice Address - Street 1:4219 SW JUNEAU ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1621
Practice Address - Country:US
Practice Address - Phone:206-207-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker