Provider Demographics
NPI:1245754977
Name:GOMEZ, MADELAINE (BEHAVIOR TECHNICIANS)
Entity Type:Individual
Prefix:
First Name:MADELAINE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIANS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 E 6TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4515
Mailing Address - Country:US
Mailing Address - Phone:786-382-9528
Mailing Address - Fax:
Practice Address - Street 1:770 E 6TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4515
Practice Address - Country:US
Practice Address - Phone:786-543-3283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician