Provider Demographics
NPI:1528865631
Name:GOMEZ ROSELL, MARIBEL D
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:D
Last Name:GOMEZ ROSELL
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 1:14903 SW 80TH ST APT 212
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3135
Mailing Address - Country:US
Mailing Address - Phone:786-523-4715
Mailing Address - Fax:
Practice Address - Street 1:14903 SW 80TH ST APT 212
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3135
Practice Address - Country:US
Practice Address - Phone:786-523-4715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-404058106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician