Provider Demographics
NPI:1255928537
Name:MORA GUTIERREZ, CELY MARIBEL (CBHCM-P)
Entity type:Individual
Prefix:
First Name:CELY
Middle Name:MARIBEL
Last Name:MORA GUTIERREZ
Suffix:
Gender:F
Credentials:CBHCM-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 MUSCAT CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3459
Mailing Address - Country:US
Mailing Address - Phone:786-859-5538
Mailing Address - Fax:
Practice Address - Street 1:1858 MUSCAT CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3459
Practice Address - Country:US
Practice Address - Phone:786-859-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-353461106S00000X
FLCBHCMP101121171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator