Provider Demographics
NPI:1235958935
Name:GONZALEZ, JOANNA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18326 SW 136TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7153
Mailing Address - Country:US
Mailing Address - Phone:786-486-0868
Mailing Address - Fax:
Practice Address - Street 1:18326 SW 136TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-7153
Practice Address - Country:US
Practice Address - Phone:786-486-0868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12399103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical