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General NPI Number Information
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NPI Number | 1083420301
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Entity Type | Individual
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Provider Name | RANDY CONCEPCION GONZALEZ M.S PSYCHOLOGY
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Gender | Male
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 07/20/2025
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Provider Practice Location Address
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Address Line | 12550 BISCAYNE BLVD STE 218
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2501
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Country | US
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Telephone | 786-614-3425
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Fax |
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Provider Business Mailing Address
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Address Line | 12665 NE 16TH AVE APT 7
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5289
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Country | US
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Telephone | 786-614-3425
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-387241
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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Taxonomy #3
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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Taxonomy #4
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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