Provider Demographics
NPI:1356862007
Name:GONZALEZ, CHARLEEN (LMFT)
Entity Type:Individual
Prefix:
First Name:CHARLEEN
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S ROYAL POINCIANA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6667
Mailing Address - Country:US
Mailing Address - Phone:305-668-9000
Mailing Address - Fax:305-662-1788
Practice Address - Street 1:10720 CARIBBEAN BLVD STE 320
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1244
Practice Address - Country:US
Practice Address - Phone:305-668-9000
Practice Address - Fax:786-231-5880
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3328106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty