Provider Demographics
NPI:1558054635
Name:GONZALEZ, KAREN K
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:K
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 1:887 XAVIOR AVE APT A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-2660
Mailing Address - Country:US
Mailing Address - Phone:786-541-3209
Mailing Address - Fax:
Practice Address - Street 1:887 XAVIOR AVE APT A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-2660
Practice Address - Country:US
Practice Address - Phone:786-541-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-272499103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst