Provider Demographics
NPI:1750436614
Name:FORT, GILZA MARIA (LMFT)
Entity type:Individual
Prefix:
First Name:GILZA
Middle Name:MARIA
Last Name:FORT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:GILZA
Other - Middle Name:MARIA
Other - Last Name:FORT MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:7765 SW 87TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2596
Mailing Address - Country:US
Mailing Address - Phone:305-412-8440
Mailing Address - Fax:305-412-8447
Practice Address - Street 1:7765 SW 87TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2596
Practice Address - Country:US
Practice Address - Phone:305-412-8440
Practice Address - Fax:305-412-8447
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist