Provider Demographics
NPI:1053766659
Name:GAMBINO, ADRIANA NANCY
Entity type:Individual
Prefix:MS
First Name:ADRIANA
Middle Name:NANCY
Last Name:GAMBINO
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 1:29 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2349
Practice Address - Country:US
Practice Address - Phone:857-254-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2019-10-30
Deactivation Date:2018-11-13
Deactivation Code:
Reactivation Date:2019-10-30
Provider Licenses
StateLicense IDTaxonomies
MA1154461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical