Healthcare Provider Details

I. General information

NPI: 1952496796
Provider Name (Legal Business Name): GLORIA CHIANG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W GORE ST STE 405
ORLANDO FL
32806-1049
US

IV. Provider business mailing address

100 W GORE ST STE 405
ORLANDO FL
32806-1049
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-5725
  • Fax: 321-843-1635
Mailing address:
  • Phone: 321-841-5725
  • Fax: 321-843-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004108
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY11308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: