Provider Demographics
NPI:1730336231
Name:DEPRIMA, GABRIELA TELLEZ (PSYD)
Entity type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:TELLEZ
Last Name:DEPRIMA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8089 BALTIC AMBER RD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2234
Mailing Address - Country:US
Mailing Address - Phone:305-905-1259
Mailing Address - Fax:
Practice Address - Street 1:2255 GLADES RD STE 324A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8571
Practice Address - Country:US
Practice Address - Phone:305-905-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8009103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA491819305AMedicaid
FLDN939ZMedicare PIN