Provider Demographics
NPI:1982298998
Name:PEREZ, GISELL (RBT)
Entity Type:Individual
Prefix:MS
First Name:GISELL
Middle Name:
Last Name:PEREZ
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 1:15985 SW 98TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6198
Mailing Address - Country:US
Mailing Address - Phone:305-304-0295
Mailing Address - Fax:
Practice Address - Street 1:70 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-5934
Practice Address - Country:US
Practice Address - Phone:305-304-0295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-153394106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician