Provider Demographics
NPI:1215770904
Name:GUTIERREZ LAGE, ARAMIS (RBT)
Entity type:Individual
Prefix:
First Name:ARAMIS
Middle Name:
Last Name:GUTIERREZ LAGE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11420 SW 250TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6039
Mailing Address - Country:US
Mailing Address - Phone:786-474-2559
Mailing Address - Fax:
Practice Address - Street 1:1380 NE MIAMI GARDENS DR STE 220F
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4720
Practice Address - Country:US
Practice Address - Phone:786-523-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-355153106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty