Licelot Gonzalez, RBT

NPI #1912372426 in Secaucus, New Jersey

Provider Information

NPI Number: 1912372426
Entity Type: Individual
Name: Licelot Gonzalez, RBT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Credential: RBT
Enumeration Date: Dec 9, 2015
Last Updated: May 8, 2016

Practice Location

Address: 600 MEADOWLANDS PKWY
Address 2: SUITE 142
City: Secaucus
State: New Jersey
ZIP Code: 07094-1633
Phone: (201) 446-7580

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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