Provider Demographics
NPI:1730959156
Name:GONZALEZ MORALES, MERCEDES MAGALY
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:MAGALY
Last Name:GONZALEZ MORALES
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 1:131 NW 85TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-8317
Mailing Address - Country:US
Mailing Address - Phone:786-333-9942
Mailing Address - Fax:
Practice Address - Street 1:10661 N KENDALL DR STE 228
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1556
Practice Address - Country:US
Practice Address - Phone:305-903-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-316270106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician