Provider Demographics
NPI:1972963023
Name:GAITAN, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:GAITAN
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 1:13415 BEDFORD MEWS CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7713
Mailing Address - Country:US
Mailing Address - Phone:561-767-1803
Mailing Address - Fax:
Practice Address - Street 1:3255 FOREST HILL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5854
Practice Address - Country:US
Practice Address - Phone:561-964-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH13505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health