Provider Demographics
NPI:1447024153
Name:GONZALEZ CLAVERO, MARIA VICTORIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:GONZALEZ CLAVERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SW 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4312
Mailing Address - Country:US
Mailing Address - Phone:786-583-7938
Mailing Address - Fax:
Practice Address - Street 1:8323 NW 12TH ST STE 206
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1840
Practice Address - Country:US
Practice Address - Phone:786-875-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-304713106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician