Provider Demographics
NPI:1699579425
Name:CEPERO GONZALEZ, GRETER (BCBA)
Entity type:Individual
Prefix:
First Name:GRETER
Middle Name:
Last Name:CEPERO GONZALEZ
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 SE 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-4521
Mailing Address - Country:US
Mailing Address - Phone:239-245-4899
Mailing Address - Fax:
Practice Address - Street 1:1310 SE 18TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-4521
Practice Address - Country:US
Practice Address - Phone:239-245-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-25-80028103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst