Provider Demographics
NPI:1750907994
Name:AVERY-PECK, GABRIELLE (PHD)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:AVERY-PECK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CONGRESS PARK DR APT 465
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4768
Mailing Address - Country:US
Mailing Address - Phone:508-284-4614
Mailing Address - Fax:
Practice Address - Street 1:4600 LINTON BLVD STE 250
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6600
Practice Address - Country:US
Practice Address - Phone:561-708-1988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLPY10299103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist