Provider Demographics
NPI:1194058651
Name:PILET, GORDON A (LCSW)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:A
Last Name:PILET
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 W MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3135
Mailing Address - Country:US
Mailing Address - Phone:813-933-8865
Mailing Address - Fax:813-933-7285
Practice Address - Street 1:718 W MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3135
Practice Address - Country:US
Practice Address - Phone:813-933-8865
Practice Address - Fax:813-933-7285
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 57991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical