Provider Demographics
NPI:1154109551
Name:GONZALEZ, NATALIE MARIE (RBT-23-297964)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RBT-23-297964
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 BABCOCK ST NE STE 105
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5019
Mailing Address - Country:US
Mailing Address - Phone:321-750-9803
Mailing Address - Fax:
Practice Address - Street 1:5420 BABCOCK ST NE STE 105
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5019
Practice Address - Country:US
Practice Address - Phone:321-750-9803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-297964106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician