Provider Demographics
NPI:1235936923
Name:GOMEZ CAPOTE, IVETTE (RBT)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:GOMEZ CAPOTE
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12711 SADDLE CLUB CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-9687
Mailing Address - Country:US
Mailing Address - Phone:786-865-4220
Mailing Address - Fax:
Practice Address - Street 1:5410 MARINER ST STE 175
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3434
Practice Address - Country:US
Practice Address - Phone:813-461-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-395392106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician