Provider Demographics
NPI:1154901403
Name:GONZALEZ, BRIANNE CARIDAD
Entity type:Individual
Prefix:MISS
First Name:BRIANNE
Middle Name:CARIDAD
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10370 SW 166TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1086
Mailing Address - Country:US
Mailing Address - Phone:305-397-6803
Mailing Address - Fax:
Practice Address - Street 1:10370 SW 166TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1086
Practice Address - Country:US
Practice Address - Phone:305-397-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB538630106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician