Provider Demographics
NPI:1346868718
Name:GONZALEZ, ANA TERESA (BCABA)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:TERESA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 SIERRA PINE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6414
Mailing Address - Country:US
Mailing Address - Phone:786-337-0976
Mailing Address - Fax:
Practice Address - Street 1:5180 W ATLANTIC AVE STE 110
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8103
Practice Address - Country:US
Practice Address - Phone:617-470-9827
Practice Address - Fax:561-372-2651
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-11
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-20-11166106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst