Provider Demographics
NPI:1033657366
Name:MAECK, GABRIEL SAYRE (LCSW)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:SAYRE
Last Name:MAECK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 OLD CORNWALLIS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1869
Mailing Address - Country:US
Mailing Address - Phone:617-549-9526
Mailing Address - Fax:
Practice Address - Street 1:2511 OLD CORNWALLIS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1869
Practice Address - Country:US
Practice Address - Phone:617-549-9526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0106151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical