Provider Demographics
NPI:1508651720
Name:MATT, GABRIELLE E
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:E
Last Name:MATT
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 1:1771 E HAZELHURST ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2848
Mailing Address - Country:US
Mailing Address - Phone:586-229-9767
Mailing Address - Fax:
Practice Address - Street 1:7011 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3691
Practice Address - Country:US
Practice Address - Phone:313-694-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician