Healthcare Provider Details

I. General information

NPI: 1245408319
Provider Name (Legal Business Name): GLADYS SALAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLADYS SALAS BERRIOS LCSW

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 OAKFIELD DR STE 205
BRANDON FL
33511-0827
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-973-1304
  • Fax: 813-355-5024
Mailing address:
  • Phone: 813-528-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW2547
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: