Provider Demographics
NPI:1144787847
Name:GONZALEZ, RUBYEIGNA (MSW)
Entity Type:Individual
Prefix:MISS
First Name:RUBYEIGNA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 AVE BARBOSA
Mailing Address - Street 2:
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962-4782
Mailing Address - Country:US
Mailing Address - Phone:787-788-4544
Mailing Address - Fax:787-788-4544
Practice Address - Street 1:168 AVE BARBOSA
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-4782
Practice Address - Country:US
Practice Address - Phone:787-788-4544
Practice Address - Fax:787-788-4544
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR140081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4472185OtherLICENCIA DE CONDUCIR
PR14008OtherLICENCIA DE TRABAJO SOCIAL