Provider Demographics
NPI:1841228566
Name:HERNANDEZ ESCAJADILLO, GLORIA M (MD, LMHC)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:M
Last Name:HERNANDEZ ESCAJADILLO
Suffix:
Gender:F
Credentials:MD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW NORTH RIVER DR APT 308
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2350
Mailing Address - Country:US
Mailing Address - Phone:786-253-1028
Mailing Address - Fax:305-547-2072
Practice Address - Street 1:1700 NW NORTH RIVER DR APT 308
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2350
Practice Address - Country:US
Practice Address - Phone:786-253-1028
Practice Address - Fax:305-547-2072
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FL171M00000X
FLMH21292101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765173200Medicaid