Provider Demographics
NPI:1164026167
Name:CAREY-JOHNSON, GABRIELLE ETRINA
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ETRINA
Last Name:CAREY-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 NE 159TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4215
Mailing Address - Country:US
Mailing Address - Phone:786-501-6363
Mailing Address - Fax:
Practice Address - Street 1:170 NE 159TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33162-4215
Practice Address - Country:US
Practice Address - Phone:786-501-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19803101YM0800X
FLIMT2609106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist