Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 103TS0200X | School Psychologist | FL |
NPI | 1013214691 |
---|---|
Provider Name | Ms. Gladys A Gaines |
First Address | Bowling Green, FL 33834-1162 |
Second Address | Sebring, FL 33870-1173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2011 |
Last Update Date | 19/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000309700 | (05) | FL |
000630100 | (05) | FL |
002313600 | (05) | FL |
002313900 | (05) | FL |
002536200 | (05) | FL |