Provider Demographics
NPI:1457858706
Name:GONZALEZ ALVARINO, MADELIN
Entity Type:Individual
Prefix:
First Name:MADELIN
Middle Name:
Last Name:GONZALEZ ALVARINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 NW 97TH AVE APT 412
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4157
Mailing Address - Country:US
Mailing Address - Phone:786-623-9218
Mailing Address - Fax:
Practice Address - Street 1:181 NW 97TH AVE APT 412
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4157
Practice Address - Country:US
Practice Address - Phone:786-623-9218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020573600Medicaid