Provider Demographics
NPI:1962296293
Name:GONZALEZ, YENISEY (MS)
Entity type:Individual
Prefix:MS
First Name:YENISEY
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:MS
Other - Prefix:MS
Other - First Name:YENISEY
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:24423 SW 118TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3413
Mailing Address - Country:US
Mailing Address - Phone:305-842-8361
Mailing Address - Fax:
Practice Address - Street 1:24423 SW 118TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-3413
Practice Address - Country:US
Practice Address - Phone:305-842-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist