Provider Demographics
NPI:1942586177
Name:GILLOMBARDO, RENEE C (LMFT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:C
Last Name:GILLOMBARDO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 ARLINGTON AVE N
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3652
Mailing Address - Country:US
Mailing Address - Phone:727-385-0209
Mailing Address - Fax:
Practice Address - Street 1:735 ARLINGTON AVE N
Practice Address - Street 2:SUITE 102
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3652
Practice Address - Country:US
Practice Address - Phone:727-385-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health