Provider Demographics
NPI:1316486095
Name:GOSN, CLELIA (MS)
Entity type:Individual
Prefix:MRS
First Name:CLELIA
Middle Name:
Last Name:GOSN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 NW 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3970
Mailing Address - Country:US
Mailing Address - Phone:954-531-9186
Mailing Address - Fax:
Practice Address - Street 1:7640 NW 70TH AVE
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-3970
Practice Address - Country:US
Practice Address - Phone:954-531-9186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling