Provider Demographics
NPI:1518480235
Name:GONZALEZ, ARLEM (RBT-18-69379)
Entity Type:Individual
Prefix:
First Name:ARLEM
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RBT-18-69379
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 NE 2ND AVE APT 1511
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-2558
Mailing Address - Country:US
Mailing Address - Phone:305-497-0940
Mailing Address - Fax:
Practice Address - Street 1:650 NE 2ND AVE APT 1511
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-2558
Practice Address - Country:US
Practice Address - Phone:305-497-0940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-69379106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG524-000-71-944-0Medicaid