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General NPI Number Information
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NPI Number | 1255888293
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Entity Type | Organization
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Legal Business Name | FAITH GISONDI, LLC
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 11/24/2023
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Provider Practice Location Address
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Address Line | 615 SW ST LUCIE CRESCENT UNIT 106
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City | STUART
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State | FL
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Zip | 34994-2860
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Country | US
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Telephone | 772-215-2181
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Fax |
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Provider Business Mailing Address
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Address Line | 615 SW ST LUCIE CRESCENT UNIT 106
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City | STUART
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State | FL
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Zip | 34994-2860
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Country | US
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Telephone | 772-215-2181
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/MANAGER
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Name | FAITH GISONDI
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Credential | LMHC
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Telephone | 772-215-2181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MH13767
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License Number State | FL
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