Provider Demographics
NPI:1982907176
Name:GALVAN DE ANTILLON, GABRIELA (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:
Last Name:GALVAN DE ANTILLON
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 226456
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33222-6456
Mailing Address - Country:US
Mailing Address - Phone:786-383-2738
Mailing Address - Fax:
Practice Address - Street 1:1000 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3353
Practice Address - Country:US
Practice Address - Phone:786-383-2738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health