Provider Demographics
NPI:1851530182
Name:MATTHEW, DEANE GAIL (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:DEANE
Middle Name:GAIL
Last Name:MATTHEW
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 INTERNATIONAL PKWY STE 2000
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5096
Mailing Address - Country:US
Mailing Address - Phone:321-689-9148
Mailing Address - Fax:
Practice Address - Street 1:1540 INTERNATIONAL PKWY STE 2000
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5096
Practice Address - Country:US
Practice Address - Phone:321-689-9148
Practice Address - Fax:321-300-0223
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9773101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health