Provider Demographics
NPI:1063233385
Name:GONZALEZ CASTILLO, NORALY
Entity type:Individual
Prefix:
First Name:NORALY
Middle Name:
Last Name:GONZALEZ CASTILLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 W 74TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4793
Mailing Address - Country:US
Mailing Address - Phone:305-775-9768
Mailing Address - Fax:
Practice Address - Street 1:995 W 74TH ST APT 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4793
Practice Address - Country:US
Practice Address - Phone:305-775-9768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-19
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-362290106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124442400Medicaid