1689564106 NPI number — GABRIELLE M SMITH LBS1 PEL LSW

Table of content: GABRIELLE M SMITH LBS1 PEL LSW (NPI 1689564106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689564106 NPI number — GABRIELLE M SMITH LBS1 PEL LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
GABRIELLE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LBS1 PEL LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NAPOLITANO
Provider Other First Name:
GABRIELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689564106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4803 DAVID ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCHENRY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60051-7966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-987-0372
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
391 NORTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTIOCH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60002-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-508-6655
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  150117003 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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