Provider Demographics
NPI:1619759198
Name:GONZALEZ VERA, AMALIA MICHELI
Entity Type:Individual
Prefix:
First Name:AMALIA
Middle Name:MICHELI
Last Name:GONZALEZ VERA
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 1:3115 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3851
Mailing Address - Country:US
Mailing Address - Phone:786-719-1782
Mailing Address - Fax:
Practice Address - Street 1:3115 SW 69TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3851
Practice Address - Country:US
Practice Address - Phone:786-719-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL106S00000X
RBT-23-304522106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician