Active NPI
Gabrielle Moira Hadorn
- Marriage & Family Therapist
- Baltimore, MD
National Provider Identifier
1639792369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- LCM977
- Practice address
- 117 N Montford Ave
Baltimore, MD 21224-1053 - Phone
- (770) 823-5288
- NPI assigned
- May 28, 2020
- Last updated
- Sep 7, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | LCM977 | MD | Primary |
Addresses
Primary practice location
117 N Montford Ave
Baltimore, MD 21224-1053
Mailing address
117 N Montford Ave
Baltimore, MD 21224-1053
Phone (770) 823-5288
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 26, 2024 through Feb 26, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCM977 | MD | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694044800000",
"number": "1639792369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 N MONTFORD AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212241053",
"telephone_number": "770-823-5288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 N MONTFORD AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212241053",
"telephone_number": "770-823-5288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HADORN",
"first_name": "GABRIELLE",
"middle_name": "MOIRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-28",
"last_updated": "2023-09-07",
"certification_date": "2023-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MD",
"license": "LCM977",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.