Provider Demographics
NPI:1770159006
Name:ZUMETA GONZALEZ, LUCY M
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:M
Last Name:ZUMETA 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 1:4733 W WATERS AVE APT 912
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1456
Mailing Address - Country:US
Mailing Address - Phone:813-450-7491
Mailing Address - Fax:
Practice Address - Street 1:4733 W WATERS AVE APT 912
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1456
Practice Address - Country:US
Practice Address - Phone:813-450-7491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLZ532533895120106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician