Provider Demographics
NPI:1366108987
Name:GONZALEZ, ILEANA (BS)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 N KENDALL DR STE 109
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1024
Mailing Address - Country:US
Mailing Address - Phone:305-243-3669
Mailing Address - Fax:305-243-3155
Practice Address - Street 1:1601 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-243-3669
Practice Address - Fax:305-243-3155
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker