Provider Demographics
NPI:1750817052
Name:PAULETTE R GIBBONS
Entity Type:Organization
Organization Name:PAULETTE R GIBBONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMHC MCAP
Authorized Official - Phone:786-374-8100
Mailing Address - Street 1:1830 RADIUS DR
Mailing Address - Street 2:APT 604
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-7702
Mailing Address - Country:US
Mailing Address - Phone:786-374-8100
Mailing Address - Fax:
Practice Address - Street 1:1830 RADIUS DR
Practice Address - Street 2:APT 604
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-7702
Practice Address - Country:US
Practice Address - Phone:786-374-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14006251S00000X
FLMCAP100270251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health