Healthcare Provider Details

I. General information

NPI: 1265368906
Provider Name (Legal Business Name): PETER ROBERT GAERLAN-DI LIBERO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 TAMIAMI TRL STE 500
PORT CHARLOTTE FL
33948-1083
US

IV. Provider business mailing address

301 SEASONS DR
PUNTA GORDA FL
33983-5807
US

V. Phone/Fax

Practice location:
  • Phone: 941-780-4268
  • Fax:
Mailing address:
  • Phone: 941-780-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: