Provider Demographics
NPI:1558086454
Name:BRITO GOMEZ, MARILEIDY (RBT)
Entity Type:Individual
Prefix:
First Name:MARILEIDY
Middle Name:
Last Name:BRITO GOMEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14750 SW 26TH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5936
Mailing Address - Country:US
Mailing Address - Phone:786-615-4750
Mailing Address - Fax:786-279-0915
Practice Address - Street 1:14750 SW 26TH ST STE 208
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5936
Practice Address - Country:US
Practice Address - Phone:786-615-4750
Practice Address - Fax:786-279-0915
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-202842106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician