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General NPI Number Information
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NPI Number | 1215697842
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Entity Type | Individual
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Provider Name | JUAN CARLOS GONZALEZ SR. CBHCM-S
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Gender | Male
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Dates
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Enumeration Date | 12/22/2021
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 640 W PALM DR STE D
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City | FLORIDA CITY
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State | FL
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Zip | 33034-3237
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Country | US
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Telephone | 786-601-7757
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Fax |
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Provider Business Mailing Address
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Address Line | 7150 SW 23RD ST APT 46
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City | MIAMI
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State | FL
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Zip | 33155-1651
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Country | US
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Telephone | 786-797-2339
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | CBHCMS.0102831
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License Number State | FL
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