Provider Demographics
NPI:1437583937
Name:GALLANT, ROBIN LYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNNE
Last Name:GALLANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 CANBY CIR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-8905
Mailing Address - Country:US
Mailing Address - Phone:407-488-2295
Mailing Address - Fax:
Practice Address - Street 1:694 CANBY CIR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-8905
Practice Address - Country:US
Practice Address - Phone:407-488-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW114541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009493000Medicaid
FL009493000Medicaid