Provider Demographics
NPI:1063079689
Name:GERARDO PATRICIO, GISEL JENNY (BCBA)
Entity type:Individual
Prefix:MS
First Name:GISEL
Middle Name:JENNY
Last Name:GERARDO PATRICIO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 VILLAGE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-8687
Mailing Address - Country:US
Mailing Address - Phone:919-358-2862
Mailing Address - Fax:
Practice Address - Street 1:1010 VILLAGE RIVER DR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8687
Practice Address - Country:US
Practice Address - Phone:919-358-2862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-19-34569103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst