| Doctor Name: | MRS. MARY LOUISE LARA GABRIEL |
| NPI Number: | 1063770998 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC, SCHOOL PSYCHOL |
| License Number: | CONTROL # 96572001 |
| Business Practice Address: | 6350 Pleasantview St Middle Village, NY - 113791844 |
| Business Phone Number: | 9176045592 |
| Business Fax Number: | 7183260995 |
| Mailing Address: | 6350 Pleasantview St, MIDDLE VILLAGE |
| State: | NY |
| Postal Code: | 113791844 |
| Phone Number: | 9176045592 |
| Fax Number: | 7183260995 |
| NPI Enumeration Date: | 04/28/2012 |
| NPI Last Update Date: | 04/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | CONTROL # 96572001 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |