Basic Information
| Provider Information | |||||||||
| NPI: | 1144534835 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONATOS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8787 BRYAN DAIRY RD STE 275 | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337771260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274575614 | ||||||||
| FaxNumber: | 7276357937 | ||||||||
| Practice Location | |||||||||
| Address1: | 8787 BRYAN DAIRY RD STE 275 | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337771260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274575614 | ||||||||
| FaxNumber: | 7276357937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2010 | ||||||||
| LastUpdateDate: | 11/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34006037A | IN | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | SW 10404 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.