Provider Demographics
NPI:1073025995
Name:LUCIANO, GABRIELA ENID (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:ENID
Last Name:LUCIANO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:ENSENADA
Mailing Address - State:PR
Mailing Address - Zip Code:00647-0939
Mailing Address - Country:US
Mailing Address - Phone:939-865-0289
Mailing Address - Fax:
Practice Address - Street 1:64 CALLE SAN MIGUEL
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653-2809
Practice Address - Country:US
Practice Address - Phone:787-673-8394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5956103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical