Provider Demographics
NPI:1033873401
Name:GONZALEZ AMARO, KATHERINA
Entity type:Individual
Prefix:
First Name:KATHERINA
Middle Name:
Last Name:GONZALEZ AMARO
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 1:12480 SW 219TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-2731
Mailing Address - Country:US
Mailing Address - Phone:786-542-3833
Mailing Address - Fax:
Practice Address - Street 1:12480 SW 219TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-2731
Practice Address - Country:US
Practice Address - Phone:786-542-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLRBT-24-368179106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker