Healthcare Provider Details

I. General information

NPI: 1083420301
Provider Name (Legal Business Name): RANDY CONCEPCION GONZALEZ M.S PSYCHOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 07/20/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12550 BISCAYNE BLVD STE 218
NORTH MIAMI FL
33181-2501
US

IV. Provider business mailing address

12665 NE 16TH AVE APT 7
NORTH MIAMI FL
33161-5289
US

V. Phone/Fax

Practice location:
  • Phone: 786-614-3425
  • Fax:
Mailing address:
  • Phone: 786-614-3425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-387241
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: