Healthcare Provider Details

I. General information

NPI: 1487412151
Provider Name (Legal Business Name): GINA GALLO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 BENEVA RD
SARASOTA FL
34233-2114
US

IV. Provider business mailing address

11161 STATE ROAD 70 E # 110-907
LAKEWOOD RANCH FL
34202-9407
US

V. Phone/Fax

Practice location:
  • Phone: 941-315-8222
  • Fax:
Mailing address:
  • Phone: 941-315-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5516
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: