Provider Demographics
NPI:1114677275
Name:GONZALEZ, ORLYS LAZARO (RBT)
Entity Type:Individual
Prefix:
First Name:ORLYS
Middle Name:LAZARO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9771 MARLIN RD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8739
Mailing Address - Country:US
Mailing Address - Phone:918-896-7716
Mailing Address - Fax:
Practice Address - Street 1:9771 MARLIN RD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8739
Practice Address - Country:US
Practice Address - Phone:918-896-7716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-206582106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician