Provider Demographics
NPI:1447985932
Name:GERARDO, NIOBET
Entity type:Individual
Prefix:
First Name:NIOBET
Middle Name:
Last Name:GERARDO
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 1:9231 SW 87TH AVE APT C7
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2443
Mailing Address - Country:US
Mailing Address - Phone:786-616-6269
Mailing Address - Fax:
Practice Address - Street 1:9231 SW 87TH AVE APT C7
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2443
Practice Address - Country:US
Practice Address - Phone:786-616-6269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-128326106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician