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General NPI Number Information
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NPI Number | 1760572499
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Entity Type | Individual
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Provider Name | GARY X LANCELOTTA PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 04/01/2012
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Provider Practice Location Address
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Address Line | 7301 SW 57TH CT STE 555
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5334
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Country | US
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Telephone | 305-668-7999
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Fax | 305-668-7988
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Provider Business Mailing Address
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Address Line | 14520 SW 77TH ST
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City | MIAMI
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State | FL
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Zip | 33183-2967
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Country | US
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Telephone | 305-386-6944
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Fax | 305-408-9892
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PY4882
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License Number State | FL
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