Provider Information for 1821509373
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MARY GAVIN CANTILLO LMHC
Sex: Female
NPI: 1821509373
Last Updated: 2017-10-23
Certification Date:
Certification Date:
Details
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NPI | 1821509373 | ||||||||
Enumeration Date | 2017-10-23 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
Mailing Address | 6756 AVENUE B SARASOTA, FL 34231-8852 United States Phone: 941-544-6264 | Fax: | ||||||||
Primary Practice Address | 2975 BEE RIDGE RD SUITE A, UNIT 1 SARASOTA, FL 34232 United States Phone: 941-312-1223 | Fax: | ||||||||
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