Provider Demographics
NPI:1457719379
Name:DESLIENS, GLORIANN J (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:GLORIANN
Middle Name:J
Last Name:DESLIENS
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 CALLOWAY DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-2138
Mailing Address - Country:US
Mailing Address - Phone:386-214-7934
Mailing Address - Fax:888-662-5340
Practice Address - Street 1:2400 CALLOWAY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-2138
Practice Address - Country:US
Practice Address - Phone:386-214-7934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-06
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 282N00000X
MALICSW126823101YM0800X
FLISW 9895104100000X
FLSW15476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No282N00000XHospitalsGeneral Acute Care Hospital