Healthcare Provider Details

I. General information

NPI: 1093096935
Provider Name (Legal Business Name): MARIA D GASCON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 CENTRAL AVE
SAINT PETERSBURG FL
33711-1237
US

IV. Provider business mailing address

175 1ST ST S APT 203
SAINT PETERSBURG FL
33701-4524
US

V. Phone/Fax

Practice location:
  • Phone: 727-323-6300
  • Fax: 727-323-6303
Mailing address:
  • Phone: 727-422-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10480
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: