Provider Demographics
NPI:1649584582
Name:GOSSET, STEPHANIE M (LMHC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:GOSSET
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 PONCE DE LEON BLVD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-445-0477
Mailing Address - Fax:305-445-0958
Practice Address - Street 1:717 PONCE DE LEON BLVD.
Practice Address - Street 2:SUITE 202
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-445-0477
Practice Address - Fax:305-445-0958
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9172101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002754300Medicaid