Provider Demographics
NPI:1346943891
Name:VERDECIA GONZALEZ, BRAYAN
Entity Type:Individual
Prefix:
First Name:BRAYAN
Middle Name:
Last Name:VERDECIA GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3412
Mailing Address - Country:US
Mailing Address - Phone:786-224-9555
Mailing Address - Fax:
Practice Address - Street 1:805 E 27TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3412
Practice Address - Country:US
Practice Address - Phone:786-224-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-262633106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician