Provider Demographics
NPI:1891165270
Name:GAYLORD, ASIA ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:ASIA
Middle Name:ROSE
Last Name:GAYLORD
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 1:11336 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-2134
Mailing Address - Country:US
Mailing Address - Phone:989-475-4605
Mailing Address - Fax:
Practice Address - Street 1:11336 TAFT ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2134
Practice Address - Country:US
Practice Address - Phone:989-475-4605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical