Provider Demographics
NPI:1215697842
Name:GONZALEZ, JUAN CARLOS SR (CBHCM-S)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:GONZALEZ
Suffix:SR
Gender:M
Credentials:CBHCM-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 SW 23RD ST APT 46
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1651
Mailing Address - Country:US
Mailing Address - Phone:786-797-2339
Mailing Address - Fax:
Practice Address - Street 1:640 W PALM DR STE D
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-3237
Practice Address - Country:US
Practice Address - Phone:786-601-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS.0102831104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty