Provider Demographics
NPI:1558938357
Name:CACERES GONZALEZ, LIETTE
Entity Type:Individual
Prefix:
First Name:LIETTE
Middle Name:
Last Name:CACERES 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 1:12090 SW 268TH ST UNIT 18
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8172
Mailing Address - Country:US
Mailing Address - Phone:813-327-3896
Mailing Address - Fax:
Practice Address - Street 1:12090 SW 268TH ST UNIT 18
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8172
Practice Address - Country:US
Practice Address - Phone:813-327-3896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst