Provider Demographics
NPI:1407427297
Name:PENA, GABRIELA (MS, BCBA)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:2901 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2319
Mailing Address - Country:US
Mailing Address - Phone:786-425-7136
Mailing Address - Fax:
Practice Address - Street 1:13195 SW 134TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4585
Practice Address - Country:US
Practice Address - Phone:786-206-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-24-73001103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician