Provider Demographics
NPI:1699433250
Name:CARRILLO TERRERO, GISELA MILAGROS
Entity type:Individual
Prefix:
First Name:GISELA
Middle Name:MILAGROS
Last Name:CARRILLO TERRERO
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 1:5466 HARDEE ST
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-7811
Mailing Address - Country:US
Mailing Address - Phone:239-440-9360
Mailing Address - Fax:
Practice Address - Street 1:5466 HARDEE ST
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7811
Practice Address - Country:US
Practice Address - Phone:239-440-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
FL12155736103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty