Provider Demographics
NPI:1902313596
Name:GONZALEZ DELGADO, ANISLEY (RBT)
Entity Type:Individual
Prefix:
First Name:ANISLEY
Middle Name:
Last Name:GONZALEZ DELGADO
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 1:28231 SW 134TH PL
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1947
Mailing Address - Country:US
Mailing Address - Phone:863-677-7643
Mailing Address - Fax:
Practice Address - Street 1:28231 SW 134TH PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1947
Practice Address - Country:US
Practice Address - Phone:863-677-7643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-124389106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician