Provider Demographics
NPI:1154863355
Name:GONZALEZ, BRITTANY (BCABA 0-20-10897)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BCABA 0-20-10897
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5865 SW STATE ROAD 73
Mailing Address - Street 2:
Mailing Address - City:KINARD
Mailing Address - State:FL
Mailing Address - Zip Code:32449-2209
Mailing Address - Country:US
Mailing Address - Phone:850-832-3199
Mailing Address - Fax:
Practice Address - Street 1:5865 SW STATE ROAD 73
Practice Address - Street 2:
Practice Address - City:KINARD
Practice Address - State:FL
Practice Address - Zip Code:32449-2209
Practice Address - Country:US
Practice Address - Phone:850-832-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-06
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-23582106S00000X
FL0-20-10897106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician