Provider Demographics
NPI:1336674134
Name:ALVAREZ PEREZ, GISELLE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:ALVAREZ PEREZ
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 ELYSIUM DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1149
Mailing Address - Country:US
Mailing Address - Phone:305-417-3002
Mailing Address - Fax:
Practice Address - Street 1:7711 N MILITARY TRL STE 1008
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6506
Practice Address - Country:US
Practice Address - Phone:561-480-1075
Practice Address - Fax:561-584-5836
Is Sole Proprietor?:No
Enumeration Date:2017-04-29
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-47326103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-21-47326OtherBACB
FL022554400Medicaid