Provider Demographics
NPI:1528569076
Name:RAEZ, GRETEL
Entity Type:Individual
Prefix:
First Name:GRETEL
Middle Name:
Last Name:RAEZ
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 1:20833 SW 125TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-5761
Mailing Address - Country:US
Mailing Address - Phone:786-546-2971
Mailing Address - Fax:
Practice Address - Street 1:12039 SW 132ND CT UNIT 28-4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4785
Practice Address - Country:US
Practice Address - Phone:786-355-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst