Provider Demographics
NPI:1508035296
Name:GAMBOA, RENE DANIEL (LMHC, BCPC)
Entity Type:Individual
Prefix:MR
First Name:RENE
Middle Name:DANIEL
Last Name:GAMBOA
Suffix:
Gender:M
Credentials:LMHC, BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27321 SW 140TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8842
Mailing Address - Country:US
Mailing Address - Phone:786-586-8215
Mailing Address - Fax:
Practice Address - Street 1:27321 SW 140TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8842
Practice Address - Country:US
Practice Address - Phone:786-586-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health