Provider Demographics
NPI:1093096935
Name:GASCON, MARIA D (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:D
Last Name:GASCON
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1237
Mailing Address - Country:US
Mailing Address - Phone:727-323-6300
Mailing Address - Fax:727-323-6303
Practice Address - Street 1:3820 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1237
Practice Address - Country:US
Practice Address - Phone:727-323-6300
Practice Address - Fax:727-323-6303
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10480101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor