Provider Demographics
NPI:1992578405
Name:GAKUU, ELIZABETH W (RBT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:W
Last Name:GAKUU
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 1:427 SUMMER PLACE LOOP
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-4800
Mailing Address - Country:US
Mailing Address - Phone:347-822-6555
Mailing Address - Fax:
Practice Address - Street 1:350 ACCEPTANCE WAY
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2788
Practice Address - Country:US
Practice Address - Phone:352-223-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-303950106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician