Provider Demographics
NPI:1356114946
Name:GORGOY BENITEZ, MASSIEL DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:MASSIEL
Middle Name:DE LA CARIDAD
Last Name:GORGOY BENITEZ
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 1:325 SURFSIDE BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-3146
Mailing Address - Country:US
Mailing Address - Phone:786-806-1022
Mailing Address - Fax:
Practice Address - Street 1:325 SURFSIDE BLVD APT 1
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154-3146
Practice Address - Country:US
Practice Address - Phone:786-806-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician