Provider Demographics
NPI:1831129667
Name:GOROSPE, DOUGLAS C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:C
Last Name:GOROSPE
Suffix:
Gender:M
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:PO BOX 44230
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4230
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-376-3998
Practice Address - Street 1:524 SKYMARKS DR
Practice Address - Street 2:UNIT 5
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7254
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-423-1150
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00032231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6417ZMedicare PIN
FLP00170212Medicare UPIN