Provider Demographics
NPI:1538557046
Name:LEONCE-MENDEZ, GABRIELLE
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:LEONCE-MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 LAKE DEBRA DR
Mailing Address - Street 2:APT.20119
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8734
Mailing Address - Country:US
Mailing Address - Phone:407-715-7453
Mailing Address - Fax:
Practice Address - Street 1:2526 LAKE DEBRA DR
Practice Address - Street 2:APT.20119
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8734
Practice Address - Country:US
Practice Address - Phone:407-715-7453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health