Provider Demographics
NPI:1144488313
Name:GANDELL, MARIA DOLORES (PHD, ACSW)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DOLORES
Last Name:GANDELL
Suffix:
Gender:F
Credentials:PHD, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271384
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-1384
Mailing Address - Country:US
Mailing Address - Phone:813-282-3618
Mailing Address - Fax:813-289-6906
Practice Address - Street 1:4406 MELTON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7218
Practice Address - Country:US
Practice Address - Phone:407-873-0759
Practice Address - Fax:813-289-6906
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW3298104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5543ZMedicare PIN