Provider Demographics
NPI:1710511472
Name:GONZALEZ, LISNEISY
Entity Type:Individual
Prefix:
First Name:LISNEISY
Middle Name:
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 1:30700 SW 156TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4340
Mailing Address - Country:US
Mailing Address - Phone:308-850-0908
Mailing Address - Fax:
Practice Address - Street 1:2925 SE 16TH AVE UNIT 202
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-2521
Practice Address - Country:US
Practice Address - Phone:308-850-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician