Provider Demographics
NPI:1417739772
Name:DE LEON GONZALEZ, LIZ DAINET (RBT-23-293145)
Entity Type:Individual
Prefix:
First Name:LIZ
Middle Name:DAINET
Last Name:DE LEON GONZALEZ
Suffix:
Gender:F
Credentials:RBT-23-293145
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 W 70TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5418
Mailing Address - Country:US
Mailing Address - Phone:786-424-5488
Mailing Address - Fax:
Practice Address - Street 1:2785 W 70TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5418
Practice Address - Country:US
Practice Address - Phone:786-424-5488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-293145103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst