Provider Demographics
NPI:1992827893
Name:PABON, GLADYS (PSY)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:PABON
Suffix:
Gender:F
Credentials:PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B32 CALLE 5
Mailing Address - Street 2:VILLAS DE CASTRO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-4619
Mailing Address - Country:US
Mailing Address - Phone:787-703-3701
Mailing Address - Fax:787-703-3701
Practice Address - Street 1:B32 CALLE 5
Practice Address - Street 2:VILLAS DE CASTRO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-4619
Practice Address - Country:US
Practice Address - Phone:787-703-3701
Practice Address - Fax:787-703-3701
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2300559OtherACAA
PR2252OtherIMC