Provider Demographics
NPI:1669960183
Name:GOLDFUSS, CARLA DENISSE (RBT)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:DENISSE
Last Name:GOLDFUSS
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 1:34415 SW 187TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034-4514
Mailing Address - Country:US
Mailing Address - Phone:786-312-8060
Mailing Address - Fax:
Practice Address - Street 1:34415 SW 187TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33034-4514
Practice Address - Country:US
Practice Address - Phone:786-312-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-09164106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician