Provider Demographics
NPI:1093075954
Name:GONSALVES, LYNDA A (PHD)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:A
Last Name:GONSALVES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:A
Other - Last Name:GONSALVES-BARNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:220 N LAKE CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-8100
Mailing Address - Country:US
Mailing Address - Phone:321-236-3587
Mailing Address - Fax:321-250-7822
Practice Address - Street 1:220 N LAKE CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743
Practice Address - Country:US
Practice Address - Phone:321-236-3587
Practice Address - Fax:321-250-7822
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No170300000XOther Service ProvidersGenetic Counselor, MS
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006262800Medicaid