Provider Demographics
NPI:1891195517
Name:CLINTON, GWENDOLYN (M A PSY)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:CLINTON
Suffix:
Gender:F
Credentials:M A PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 DOUGLAS AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5206
Mailing Address - Country:US
Mailing Address - Phone:407-600-9219
Mailing Address - Fax:407-354-3174
Practice Address - Street 1:801 DOUGLAS AVE STE 208
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-5206
Practice Address - Country:US
Practice Address - Phone:407-600-9219
Practice Address - Fax:407-354-3174
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator