Provider Demographics
NPI:1275944852
Name:RENEE C. GILLOMBARDO, LMFT, PA
Entity Type:Organization
Organization Name:RENEE C. GILLOMBARDO, LMFT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:GILLOMBARDO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:727-385-0208
Mailing Address - Street 1:735 ARLINGTON AVENUEN NORTH
Mailing Address - Street 2:102
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:727-385-0209
Mailing Address - Fax:
Practice Address - Street 1:735 ARLINGTON AVENUEN NORTH
Practice Address - Street 2:102
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-385-0209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1628106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty