Individual
BENJAMIN D. GALLOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, CAP, AHCT
Contact information
Practice address
2900 W PROSPECT RD, FORT LAUDERDALE, FL 33309-2519
(954) 770-2363
Mailing address
733 N.W. 30TH COURT, APT 7, WILTON MANORS, FL 33311-1798
(786) 216-9868
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAP4290
FL
101YM0800X
Mental Health Counselor
SW8346
FL
1041C0700X
Clinical Social Worker
Primary
SW8346
FL
Other
Enumeration date
07/26/2012
Last updated
06/02/2014
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