Provider Demographics
NPI:1093510240
Name:ALFONSO, GENESIS CELIA (BCABA)
Entity type:Individual
Prefix:MS
First Name:GENESIS
Middle Name:CELIA
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17770 NW 87TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6608
Mailing Address - Country:US
Mailing Address - Phone:305-842-1215
Mailing Address - Fax:
Practice Address - Street 1:17770 NW 87TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6608
Practice Address - Country:US
Practice Address - Phone:305-842-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-405002106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician