MEDICARE: MAYLIN GONZALEZ

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		GA

General Provider Information

NPI Number	:	1346104551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYLIN GONZALEZ

Provider Business Mailing Address
First Line	:	1223 AUGUSTA AVE STE 22
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-3201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 AUGUSTA AVE STE 22
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-3201
Country	:	US
Telephone Number	:	305-420-8548
Fax Number	:

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

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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