MEDICARE: GABRIELA ELIZALDE-OCASIO

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1942759477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA ELIZALDE-OCASIO

Provider Business Mailing Address
First Line	:	105 RIVER POINTE WAY
Second Line	:	APT 3312
City	:	LAWRENCE
State	:	MA
Zip	:	01843-3844
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 RIVER POINTE WAY
Second Line	:	APT 3312
City	:	LAWRENCE
State	:	MA
Zip	:	01843-3844
Country	:	US
Telephone Number	:	787-507-3509
Fax Number	:

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

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	09/26/2016

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