Healthcare Provider Details

I. General information

NPI: 1689134520
Provider Name (Legal Business Name): STEPHANIA COMEAU GASKIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BAY PINES BLVD BAY PINES
BAY PINES FL
33744-8200
US

IV. Provider business mailing address

376 BOYLE RD
SELDEN NY
11784-1236
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax:
Mailing address:
  • Phone: 631-836-6848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: