Provider Demographics
NPI:1407511249
Name:ST. JUSTE, BEN-GASSENDI (MA, MS,PHD CANDIDATE)
Entity Type:Individual
Prefix:
First Name:BEN-GASSENDI
Middle Name:
Last Name:ST. JUSTE
Suffix:
Gender:F
Credentials:MA, MS,PHD CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 LAKE WESTON DR APT 814
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-4462
Mailing Address - Country:US
Mailing Address - Phone:516-655-7746
Mailing Address - Fax:
Practice Address - Street 1:3550 N GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8823
Practice Address - Country:US
Practice Address - Phone:321-441-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist