Provider Demographics
NPI:1154872612
Name:GONZALEZ, MELANIE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ARLEE
Other - Last Name:GONZALEZ ROSALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2603 EAGLE CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3174
Mailing Address - Country:US
Mailing Address - Phone:407-288-4775
Mailing Address - Fax:
Practice Address - Street 1:2603 EAGLE CLIFF DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3174
Practice Address - Country:US
Practice Address - Phone:407-288-4775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
FLRBT-18-60245106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other