Provider Demographics
NPI:1598842528
Name:CLELLAND, GAYLE L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:L
Last Name:CLELLAND
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 1:620 HELICON TER
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-5954
Mailing Address - Country:US
Mailing Address - Phone:772-643-2838
Mailing Address - Fax:
Practice Address - Street 1:620 HELICON TER
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-5954
Practice Address - Country:US
Practice Address - Phone:772-643-2838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW94191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1184934671OtherCORPORATE NATIONAL PROVIDER IDENTIFIER