Provider Demographics
NPI:1821483637
Name:GABLES PSYCHOLOGY AND WELLNESS ASSOCIATES
Entity Type:Organization
Organization Name:GABLES PSYCHOLOGY AND WELLNESS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YUSIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIJO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-205-1965
Mailing Address - Street 1:1390 S DIXIE HWY
Mailing Address - Street 2:SUITE 2211/2212
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2927
Mailing Address - Country:US
Mailing Address - Phone:786-565-7422
Mailing Address - Fax:
Practice Address - Street 1:1390 S DIXIE HWY
Practice Address - Street 2:SUITE 2211/2212
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2927
Practice Address - Country:US
Practice Address - Phone:786-565-7422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9937251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health