Provider Demographics
NPI:1740152503
Name:GONZALEZ REGALADO, AMALIA
Entity type:Individual
Prefix:
First Name:AMALIA
Middle Name:
Last Name:GONZALEZ REGALADO
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 1:4070 TIVOLI CT APT 303
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-4241
Mailing Address - Country:US
Mailing Address - Phone:561-541-4023
Mailing Address - Fax:
Practice Address - Street 1:4070 TIVOLI CT APT 303
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-4241
Practice Address - Country:US
Practice Address - Phone:561-541-4023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician