Provider Demographics
NPI:1619354065
Name:GORDILLO, DORELYS
Entity Type:Individual
Prefix:
First Name:DORELYS
Middle Name:
Last Name:GORDILLO
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 1:3741 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3612
Mailing Address - Country:US
Mailing Address - Phone:305-713-5952
Mailing Address - Fax:305-397-1287
Practice Address - Street 1:3741 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3612
Practice Address - Country:US
Practice Address - Phone:305-713-5952
Practice Address - Fax:305-397-1287
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker