Provider Demographics
NPI:1871031575
Name:BECKETT, GABRIELLE LYNNE
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:LYNNE
Last Name:BECKETT
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 1:811 BOWERS AVE
Mailing Address - Street 2:
Mailing Address - City:RUNNEMEDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08078-1002
Mailing Address - Country:US
Mailing Address - Phone:609-980-8692
Mailing Address - Fax:
Practice Address - Street 1:811 BOWERS AVE
Practice Address - Street 2:
Practice Address - City:RUNNEMEDE
Practice Address - State:NJ
Practice Address - Zip Code:08078-1002
Practice Address - Country:US
Practice Address - Phone:609-980-8692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health