Healthcare Provider Details

I. General information

NPI: 1346345618
Provider Name (Legal Business Name): WILLIAM CHARLES GAMBERINO M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/20/2025
Certification Date: 09/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MONROE STREET SUITE 800 (PRIVATE OFFICE 860)
TALLAHASSEE FL
32301-1500
US

IV. Provider business mailing address

109 W. 27TH STREET, SUITE 5S
NEW YORK NY
10001-6208
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax: 888-815-3583
Mailing address:
  • Phone: 833-351-8255
  • Fax: 888-815-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME 74599
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME 74599
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME 74599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: