Provider Demographics
NPI:1396319844
Name:GONZALEZ GONZALEZ, YESLEYDI (RBT)
Entity type:Individual
Prefix:
First Name:YESLEYDI
Middle Name:
Last Name:GONZALEZ GONZALEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 N 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5505
Mailing Address - Country:US
Mailing Address - Phone:786-300-2960
Mailing Address - Fax:
Practice Address - Street 1:961 N 73RD AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5505
Practice Address - Country:US
Practice Address - Phone:786-300-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-166364106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician