MEDICARE: MISS GLORIA SOFIA BENCOSME LMHC, NCC, RPT,BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH 12298	FL
2	103K00000X	Behavior Analyst	1-21-54866	FL

General Provider Information

NPI Number	:	1881954824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GLORIA SOFIA BENCOSME LMHC, NCC, RPT,BCBA

Provider Business Mailing Address
First Line	:	123 WAKULLA SPRINGS WAY
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-4219
Country	:	US
Telephone Number	:	561-420-3810
Fax Number	:

Provider Business Practice Location Address
First Line	:	12300 S SHORE BLVD STE 222
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6509
Country	:	US
Telephone Number	:	561-420-3810
Fax Number	:	561-584-7803

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2012
Last Update Date	:	03/30/2025

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