Healthcare Provider Details

I. General information

NPI: 1306752852
Provider Name (Legal Business Name): BENOIT MARIE SALLY GOUSSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3581 NW 88TH DR APT 306
CORAL SPRINGS FL
33065-1996
US

IV. Provider business mailing address

3581 NW 88TH DR APT 306
CORAL SPRINGS FL
33065-1996
US

V. Phone/Fax

Practice location:
  • Phone: 954-288-1151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: