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General NPI Number Information
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NPI Number | 1821483637
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Entity Type | Organization
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Legal Business Name | GABLES PSYCHOLOGY AND WELLNESS ASSOCIATES
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 1390 S DIXIE HWY SUITE 2211/2212
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City | CORAL GABLES
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State | FL
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Zip | 33146-2927
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Country | US
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Telephone | 786-565-7422
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Fax |
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Provider Business Mailing Address
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Address Line | 1390 S DIXIE HWY SUITE 2211/2212
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City | CORAL GABLES
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State | FL
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Zip | 33146-2927
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Country | US
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Telephone | 786-565-7422
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. YUSIMI SIJO
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Credential | PSY.D
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Telephone | 305-205-1965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH9937
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License Number State | FL
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