Provider Demographics
NPI:1790095875
Name:RIOS-SERRANO, GYPSY ELAINE (LMHC)
Entity Type:Individual
Prefix:
First Name:GYPSY
Middle Name:ELAINE
Last Name:RIOS-SERRANO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11831 SW 196 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-4358
Mailing Address - Country:US
Mailing Address - Phone:305-450-8930
Mailing Address - Fax:
Practice Address - Street 1:3001 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6824
Practice Address - Country:US
Practice Address - Phone:305-450-8930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP4764101YA0400X
FLMH8873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)