Provider Demographics
NPI:1073548319
Name:DEOLIVEIRA, GWENDOLYN WESTERHOFF (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:WESTERHOFF
Last Name:DEOLIVEIRA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 IOWA AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3427
Mailing Address - Country:US
Mailing Address - Phone:727-480-1515
Mailing Address - Fax:727-545-5655
Practice Address - Street 1:3737 1ST ST NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1403
Practice Address - Country:US
Practice Address - Phone:727-480-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0004738101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health