Provider Demographics
NPI:1760283105
Name:GONZALEZ, ANISLEIDIS (CBHCM)
Entity type:Individual
Prefix:
First Name:ANISLEIDIS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:CBHCM
Other - Prefix:
Other - First Name:ANISLEIDIS
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29003 S DIXIE HWY APT 319
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-2321
Mailing Address - Country:US
Mailing Address - Phone:786-407-8193
Mailing Address - Fax:786-407-8193
Practice Address - Street 1:29003 S DIXIE HWY APT 319
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-2321
Practice Address - Country:US
Practice Address - Phone:786-407-8193
Practice Address - Fax:786-407-8193
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0106913-P101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health