Provider Demographics
NPI:1457955924
Name:FLORES, GISELLE (MSW)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE CARAMBOLA 2987
Mailing Address - Street 2:URB. LOS CAOBOS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2738
Mailing Address - Country:US
Mailing Address - Phone:787-454-6010
Mailing Address - Fax:
Practice Address - Street 1:CALLE CARAMBOLA 2987
Practice Address - Street 2:URB. LOS CAOBOS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2738
Practice Address - Country:US
Practice Address - Phone:787-454-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR96451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9645Medicaid