Provider Demographics
NPI:1568702454
Name:PEREZ-FUENTES, GABRIELA
Entity Type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:
Last Name:PEREZ-FUENTES
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 1:44 LISPENARD ST
Mailing Address - Street 2:APT 3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2550
Mailing Address - Country:US
Mailing Address - Phone:917-658-4453
Mailing Address - Fax:
Practice Address - Street 1:44 LISPENARD ST
Practice Address - Street 2:APT 3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2550
Practice Address - Country:US
Practice Address - Phone:917-658-4453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68 P86342103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical