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General NPI Number Information
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NPI Number | 1376707877
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Entity Type | Individual
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Provider Name | GISELLE CARIDAD MALLON LMHC
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Gender | Female
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 8180 NW 36TH ST SUITE 100-C
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City | DORAL
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State | FL
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Zip | 33166-6645
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Country | US
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Telephone | 305-753-2671
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Fax |
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Provider Business Mailing Address
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Address Line | 4727 NW 4TH ST
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City | MIAMI
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State | FL
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Zip | 33126-2113
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Country | US
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Telephone | 305-443-0899
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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 | MH9366
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License Number State | FL
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