Provider Demographics
NPI:1477044964
Name:GONZALEZ, MARIEN
Entity Type:Individual
Prefix:
First Name:MARIEN
Middle Name:
Last Name:GONZALEZ
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 1:16915 SW 93RD ST APT 13-211
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1010
Mailing Address - Country:US
Mailing Address - Phone:786-759-3949
Mailing Address - Fax:
Practice Address - Street 1:16915 SW 93RD ST APT 13-211
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1010
Practice Address - Country:US
Practice Address - Phone:786-759-3949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician