Provider Demographics
NPI:1871625301
Name:GONZALEZ, ISAURA DE LA CARIDAD (PSY D)
Entity type:Individual
Prefix:DR
First Name:ISAURA
Middle Name:DE LA CARIDAD
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1867
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07653-1867
Mailing Address - Country:US
Mailing Address - Phone:718-982-0231
Mailing Address - Fax:
Practice Address - Street 1:105 BYRNE AVE
Practice Address - Street 2:BASEMENT SUITE
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4406
Practice Address - Country:US
Practice Address - Phone:718-982-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015972-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM7151Medicare UPIN