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General NPI Number Information
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NPI Number | 1902618077
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Entity Type | Organization
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Legal Business Name | PELICANO, LLC
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 1340 POYDRAS ST STE 1770
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City | NEW ORLEANS
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State | LA
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Zip | 70112-5204
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Country | US
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Telephone | 727-834-0034
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Fax |
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Provider Business Mailing Address
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Address Line | 1645 PALM BEACH LAKES BLVD STE 1200
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-2214
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Country | US
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Telephone | 727-834-0034
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. GUSTAVO SEGURA HERNANDEZ
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Credential | PHD
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Telephone | 727-834-0034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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