Provider Demographics
NPI:1093389215
Name:GONZALEZ, CINDY M (CAADC, MA)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CAADC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 ALTO ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-7615
Mailing Address - Country:US
Mailing Address - Phone:401-345-6756
Mailing Address - Fax:
Practice Address - Street 1:148 ALTO ST
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-7615
Practice Address - Country:US
Practice Address - Phone:401-345-6756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty