Provider Demographics
NPI:1922236066
Name:GANNON, LYNDA COOK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:COOK
Last Name:GANNON
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 1:10144 ARBOR RUN DR
Mailing Address - Street 2:UNIT 13
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3566
Mailing Address - Country:US
Mailing Address - Phone:305-308-5066
Mailing Address - Fax:
Practice Address - Street 1:27604 CASHFORD CIR
Practice Address - Street 2:SUITE 102 A
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6952
Practice Address - Country:US
Practice Address - Phone:813-838-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-28
Last Update Date:2009-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 71231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical