Provider Demographics
NPI:1346821782
Name:REINA GONZALEZ, LORAINE
Entity Type:Individual
Prefix:
First Name:LORAINE
Middle Name:
Last Name:REINA GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13715 SW 66TH ST APT A-201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2235
Mailing Address - Country:US
Mailing Address - Phone:786-991-3766
Mailing Address - Fax:
Practice Address - Street 1:13715 SW 66TH ST APT A-201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2235
Practice Address - Country:US
Practice Address - Phone:786-991-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-157713106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician