Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor |
NPI | 1003255787 |
---|---|
Provider Name | Gabrielle Buschalla |
First Address | Worcester, MA 01605-1906 |
Second Address | Worcester, MA 01605-1906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2013 |
Last Update Date | 17/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1306461 | (05) | MA |
1308785 | (05) | MA |
22220002001 | BLUE CROSS BLUE SHEILD (01) | MA |
M18684 | BLUE CROSS BLUE SHEILD (01) | MA |