Provider Demographics
NPI:1942759477
Name:ELIZALDE-OCASIO, GABRIELA
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:ELIZALDE-OCASIO
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 1:105 RIVER POINTE WAY
Mailing Address - Street 2:APT 3312
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 RIVER POINTE WAY
Practice Address - Street 2:APT 3312
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3844
Practice Address - Country:US
Practice Address - Phone:787-507-3509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor