Provider Demographics
NPI:1881954824
Name:BENCOSME, GLORIA SOFIA (LMHC, NCC, RPT,BCBA)
Entity type:Individual
Prefix:MISS
First Name:GLORIA
Middle Name:SOFIA
Last Name:BENCOSME
Suffix:
Gender:F
Credentials:LMHC, NCC, RPT,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 WAKULLA SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4219
Mailing Address - Country:US
Mailing Address - Phone:561-420-3810
Mailing Address - Fax:
Practice Address - Street 1:12300 S SHORE BLVD STE 222
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6509
Practice Address - Country:US
Practice Address - Phone:561-420-3810
Practice Address - Fax:561-584-7803
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 12298101YM0800X
FL1-21-54866103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health