Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YP1600X | Pastoral Counselor | ||
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1093075954 |
---|---|
Provider Name | Mrs. Lynda A Gonsalves |
First Address | Kissimmee, FL 34743-8100 |
Second Address | Kissimmee, FL 34743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2012 |
Last Update Date | 06/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006262800 | (05) | FL |