Provider Demographics
NPI:1770149650
Name:CEBALLOS FRANCO, GABRIEL (MED)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:CEBALLOS FRANCO
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W BROAD ST STE 204
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5229
Mailing Address - Country:US
Mailing Address - Phone:484-522-4549
Mailing Address - Fax:
Practice Address - Street 1:701 W BROAD ST STE 204
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5229
Practice Address - Country:US
Practice Address - Phone:484-954-8327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty