Provider Demographics
NPI:1609155860
Name:DOMINGUEZ-PEREIRA, GABRIEL (PHD, LMHC, CAADC)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:DOMINGUEZ-PEREIRA
Suffix:
Gender:M
Credentials:PHD, LMHC, CAADC
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 228044
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33222-8044
Mailing Address - Country:US
Mailing Address - Phone:786-449-6612
Mailing Address - Fax:
Practice Address - Street 1:8360 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2042
Practice Address - Country:US
Practice Address - Phone:786-449-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15420101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor