Provider Demographics
NPI:1578055539
Name:GONZALEZ, MARIA F
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:F
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7896 NW 110TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7896 NW 110TH DR # DE
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-4721
Practice Address - Country:US
Practice Address - Phone:954-600-1709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2024-12-04
Deactivation Date:2024-06-29
Deactivation Code:
Reactivation Date:2024-08-29
Provider Licenses
StateLicense IDTaxonomies
MA10002301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty