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General NPI Number Information
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NPI Number | 1104560465
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Entity Type | Individual
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Provider Name | GILBERT SIERRA
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Gender | Male
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Dates
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Enumeration Date | 04/22/2022
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 4905 LANTANA RD
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City | LAKE WORTH
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State | FL
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Zip | 33463-6915
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Country | US
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Telephone | 561-340-7269
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Fax |
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Provider Business Mailing Address
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Address Line | 2560 SW 10TH CT
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-7807
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Country | US
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Telephone | 585-503-1183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ISW14574
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License Number State | FL
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