Provider Demographics
NPI:1275305179
Name:GONZALEZ ROMERO, FATIMA SUSANA (CBHCMS)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:SUSANA
Last Name:GONZALEZ ROMERO
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 SW 24TH ST APT B322
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2564
Mailing Address - Country:US
Mailing Address - Phone:786-920-9137
Mailing Address - Fax:
Practice Address - Street 1:10225 SW 24TH ST APT B322
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2564
Practice Address - Country:US
Practice Address - Phone:786-920-9137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0102669104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker