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General NPI Number Information
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NPI Number | 1316485675
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Entity Type | Organization
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Legal Business Name | LINDSEY GULLO, LLC, LCSW
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 305 N VILLA SAN MARCO DR 104
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5104
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Country | US
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Telephone | 716-696-0378
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Fax |
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Provider Business Mailing Address
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Address Line | 4475 US 1 S
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-7284
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LINDSEY GULLO
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Credential | LCSW
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Telephone | 904-719-3902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SW13172
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License Number State | FL
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