Provider Demographics
NPI:1760706261
Name:GULLO, LINDSEY (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:GULLO
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 1:4475 US 1 S
Mailing Address - Street 2:608
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7284
Mailing Address - Country:US
Mailing Address - Phone:716-696-0378
Mailing Address - Fax:
Practice Address - Street 1:4475 US 1 S
Practice Address - Street 2:608
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7284
Practice Address - Country:US
Practice Address - Phone:716-696-0378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical