Provider Demographics
NPI:1992012280
Name:GOLD, GWEN (LMHC)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2688 FRUITVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237
Mailing Address - Country:US
Mailing Address - Phone:941-366-2224
Mailing Address - Fax:941-366-2982
Practice Address - Street 1:2688 FRUITVILLE ROAD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237
Practice Address - Country:US
Practice Address - Phone:941-366-2224
Practice Address - Fax:941-366-2982
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10417101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor