Provider Demographics
NPI:1790707990
Name:GAUDIOSI, ELISA (LSCW)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:GAUDIOSI
Suffix:
Gender:F
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 ALTON RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-5504
Mailing Address - Country:US
Mailing Address - Phone:305-538-8835
Mailing Address - Fax:305-532-5766
Practice Address - Street 1:1221 71ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33141-3647
Practice Address - Country:US
Practice Address - Phone:305-538-8835
Practice Address - Fax:305-865-1881
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW74171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical