Provider Demographics
NPI:1598988776
Name:FONTE, GUSTAVO ALBERTO (PHD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ALBERTO
Last Name:FONTE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SW 8TH ST
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-3003
Mailing Address - Country:US
Mailing Address - Phone:305-423-7062
Mailing Address - Fax:
Practice Address - Street 1:80 SW 8TH ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3003
Practice Address - Country:US
Practice Address - Phone:305-423-7062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59524Medicare ID - Type Unspecified