Provider Demographics
NPI:1467284463
Name:DIAZ GONZALEZ, SUSANA (RBT)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:DIAZ 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 1:2316 SW 17TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-3581
Mailing Address - Country:US
Mailing Address - Phone:239-414-5035
Mailing Address - Fax:
Practice Address - Street 1:2316 SW 17TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-3581
Practice Address - Country:US
Practice Address - Phone:239-414-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-365065106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician