Provider Demographics
NPI:1558574012
Name:GOULD, CYNTHIA GENEVIEVE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:GENEVIEVE
Last Name:GOULD
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 1:1401 DEVONSHIRE DR N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4823
Mailing Address - Country:US
Mailing Address - Phone:727-354-8268
Mailing Address - Fax:727-381-2347
Practice Address - Street 1:6727 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1339
Practice Address - Country:US
Practice Address - Phone:727-345-9192
Practice Address - Fax:727-381-2347
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6849101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6733Medicare ID - Type Unspecified