Provider Demographics
NPI:1992445043
Name:GONZALEZ SUAREZ, YANETSI (BCBA)
Entity type:Individual
Prefix:
First Name:YANETSI
Middle Name:
Last Name:GONZALEZ SUAREZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 SW 67TH AVE APT 34
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4729
Mailing Address - Country:US
Mailing Address - Phone:786-209-5571
Mailing Address - Fax:
Practice Address - Street 1:1916 NW 84TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1030
Practice Address - Country:US
Practice Address - Phone:305-224-1929
Practice Address - Fax:786-441-2169
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-56126103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst