MEDICARE: DR. GABRIELA M MANCINI PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY 8317	FL

General Provider Information

NPI Number	:	1558649889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIELA M MANCINI PSY.D.

Provider Business Mailing Address
First Line	:	125 S STATE ROAD 7
Second Line	:	# 104-449
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4385
Country	:	US
Telephone Number	:	954-553-8182
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 S STATE ROAD 7
Second Line	:	# 104-449
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4385
Country	:	US
Telephone Number	:	561-203-5867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	07/02/2019

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