Healthcare Provider Details

I. General information

NPI: 1255888293
Provider Name (Legal Business Name): FAITH GISONDI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 11/24/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SW ST LUCIE CRESCENT UNIT 106
STUART FL
34994-2860
US

IV. Provider business mailing address

615 SW ST LUCIE CRESCENT UNIT 106
STUART FL
34994-2860
US

V. Phone/Fax

Practice location:
  • Phone: 772-215-2181
  • Fax:
Mailing address:
  • Phone: 772-215-2181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMH13767
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FAITH GISONDI
Title or Position: PRESIDENT/MANAGER
Credential: LMHC
Phone: 772-215-2181