Provider Demographics
NPI:1932973229
Name:GONZALEZ, GISELA (RBT)
Entity Type:Individual
Prefix:
First Name:GISELA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 NE 9TH DR UNIT 204
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5896
Mailing Address - Country:US
Mailing Address - Phone:786-203-8098
Mailing Address - Fax:
Practice Address - Street 1:3415 NE 9TH DR UNIT 204
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5896
Practice Address - Country:US
Practice Address - Phone:786-203-8098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-280933106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician