Provider Demographics
NPI:1396281358
Name:GONZALEZ ESPARZA, MARILYN (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:GONZALEZ ESPARZA
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 E MCDOWELL RD STE 175
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7725
Mailing Address - Country:US
Mailing Address - Phone:480-478-0444
Mailing Address - Fax:602-854-7422
Practice Address - Street 1:4801 E MCDOWELL RD STE 175
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-7725
Practice Address - Country:US
Practice Address - Phone:480-478-0444
Practice Address - Fax:602-854-7422
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-46501103K00000X
AZBEH-001000103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst