MEDICARE: AMBER GONZALEZ BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-21-177300	IN
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1861165896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER GONZALEZ BCBA

Provider Business Mailing Address
First Line	:	10419 CALUMET AVE STE B
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-4059
Country	:	US
Telephone Number	:	219-491-1759
Fax Number	:

Provider Business Practice Location Address
First Line	:	10419 CALUMET AVE
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-4059
Country	:	US
Telephone Number	:	219-491-1759
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	06/25/2025

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