Provider Demographics
NPI:1124725908
Name:GONZALEZ, LUCILLE EDITH (RBT)
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:EDITH
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 MAIN ST
Mailing Address - Street 2:PO BOX 99
Mailing Address - City:STRAUSSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19559
Mailing Address - Country:US
Mailing Address - Phone:475-775-3317
Mailing Address - Fax:
Practice Address - Street 1:350 E CONESTOGA ST
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-1308
Practice Address - Country:US
Practice Address - Phone:421-671-7418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician