Provider Demographics
NPI:1720444896
Name:GABRY, KAMAL (LMT)
Entity type:Individual
Prefix:
First Name:KAMAL
Middle Name:
Last Name:GABRY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12773 FOREST HILL BLVD STE 1213
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4760
Mailing Address - Country:US
Mailing Address - Phone:561-510-4355
Mailing Address - Fax:
Practice Address - Street 1:12773 FOREST HILL BLVD STE 1213
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4760
Practice Address - Country:US
Practice Address - Phone:561-510-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126599103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)