Provider Demographics
NPI:1619378924
Name:GLORIOSO, ALLISON (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:GLORIOSO
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15050 ELDERBERRY LN
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8504
Mailing Address - Country:US
Mailing Address - Phone:239-789-8464
Mailing Address - Fax:844-308-8873
Practice Address - Street 1:15050 ELDERBERRY LN
Practice Address - Street 2:SUITE 4
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8504
Practice Address - Country:US
Practice Address - Phone:239-789-8464
Practice Address - Fax:844-308-8873
Is Sole Proprietor?:No
Enumeration Date:2014-09-07
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH11665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health