Provider Demographics
NPI:1336685619
Name:GONZALEZ, MAGGE L (CBHCM)
Entity Type:Individual
Prefix:
First Name:MAGGE
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:MAGGE
Other - Middle Name:L
Other - Last Name:KEFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CBHCM
Mailing Address - Street 1:12751 SOPHIAMARIE LOOP
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7180
Mailing Address - Country:US
Mailing Address - Phone:304-380-3342
Mailing Address - Fax:304-380-3342
Practice Address - Street 1:1999 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7021
Practice Address - Country:US
Practice Address - Phone:304-380-3342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X171M00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator