Provider Demographics
NPI:1265968168
Name:GONZALEZ VARELA, JANET
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:GONZALEZ VARELA
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 1:15231 SW 80TH ST APT 214
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1357
Mailing Address - Country:US
Mailing Address - Phone:786-447-6148
Mailing Address - Fax:
Practice Address - Street 1:9290 HAMMOCKS BLVD STE 401
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196
Practice Address - Country:US
Practice Address - Phone:561-305-6971
Practice Address - Fax:786-913-7034
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-70510106S00000X
FL1-21-57018103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty