Provider Demographics
NPI:1396206025
Name:GOSNELL, MARITA MERCEDES (RBT)
Entity Type:Individual
Prefix:MS
First Name:MARITA
Middle Name:MERCEDES
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:
Other - Last Name:GOSNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:624 RENAISSANCE POINTE APT 101
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3510
Mailing Address - Country:US
Mailing Address - Phone:321-594-3890
Mailing Address - Fax:
Practice Address - Street 1:1160 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1461
Practice Address - Country:US
Practice Address - Phone:407-745-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician