Provider Demographics
NPI:1235303702
Name:GONZALEZ, YARITSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:YARITSA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHD
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 193416
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3416
Mailing Address - Country:US
Mailing Address - Phone:787-530-4882
Mailing Address - Fax:787-753-1222
Practice Address - Street 1:399 MUNOZ RIVERA LOCAL 5B
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-909-0123
Practice Address - Fax:787-752-1222
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2982103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical