Provider Demographics
NPI:1083824627
Name:GONZALEZ, MARIA C (MS)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:C
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 NE 5TH AVE APT 317
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4019
Mailing Address - Country:US
Mailing Address - Phone:305-571-9695
Mailing Address - Fax:
Practice Address - Street 1:3301 NE 5TH AVE APT 317
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4019
Practice Address - Country:US
Practice Address - Phone:305-571-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1280106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist