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General NPI Number Information
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NPI Number | 1568718682
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Entity Type | Individual
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Provider Name | BENJAMIN D. GALLOSO LCSW, CAP, AHCT
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Gender | Male
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 2900 W PROSPECT RD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-2519
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Country | US
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Telephone | 954-770-2363
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Fax |
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Provider Business Mailing Address
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Address Line | 733 N.W. 30TH COURT APT 7
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City | WILTON MANORS
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State | FL
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Zip | 33311-1798
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Country | US
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Telephone | 786-216-9868
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAP4290
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW8346
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SW8346
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License Number State | FL
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