Provider Demographics
NPI:1750897260
Name:GONZALEZ, NAIRIM JOSEPHINE (BCBA)
Entity type:Individual
Prefix:MISS
First Name:NAIRIM
Middle Name:JOSEPHINE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10830 SW 84TH ST APT G3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3862
Mailing Address - Country:US
Mailing Address - Phone:786-203-8206
Mailing Address - Fax:
Practice Address - Street 1:10830 SW 84TH ST APT G3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3862
Practice Address - Country:US
Practice Address - Phone:786-203-8206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023024700Medicaid