Provider Demographics
NPI:1306572565
Name:GONZALEZ CHADIS, ARIESTA
Entity type:Individual
Prefix:MISS
First Name:ARIESTA
Middle Name:
Last Name:GONZALEZ CHADIS
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 1:9360 FONTAINEBLEAU BLVD APT 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5608
Mailing Address - Country:US
Mailing Address - Phone:786-238-5487
Mailing Address - Fax:
Practice Address - Street 1:9360 FONTAINEBLEAU BLVD APT 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-5608
Practice Address - Country:US
Practice Address - Phone:786-238-5487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-157365106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician