Provider Demographics
NPI:1245191626
Name:GUSTO, JENNA GAYLE
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:GAYLE
Last Name:GUSTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 GRAND CAYMAN ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-2830
Mailing Address - Country:US
Mailing Address - Phone:941-780-2231
Mailing Address - Fax:
Practice Address - Street 1:2616 GRAND CAYMAN ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-2830
Practice Address - Country:US
Practice Address - Phone:941-780-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG230-427-02-868-0106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician