Provider Demographics
NPI:1447664842
Name:GONZALEZ, JOSE (PYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 114
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0114
Mailing Address - Country:US
Mailing Address - Phone:787-378-4112
Mailing Address - Fax:
Practice Address - Street 1:BARCELO #12 ESQ 173
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-0000
Practice Address - Country:US
Practice Address - Phone:787-739-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5318103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling