Provider Demographics
NPI:1952988875
Name:BARRERA GONZALEZ, MAIDY CARENIA
Entity type:Individual
Prefix:
First Name:MAIDY
Middle Name:CARENIA
Last Name:BARRERA 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 1:15125 SW 305TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4427
Mailing Address - Country:US
Mailing Address - Phone:786-499-3930
Mailing Address - Fax:
Practice Address - Street 1:6801 LAKE WORTH RD STE 115
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2965
Practice Address - Country:US
Practice Address - Phone:561-283-7181
Practice Address - Fax:561-909-0863
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-22-13857106E00000X
FL20-117958106S00000X
FL1-23-66201103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician