Provider Demographics
NPI:1235515081
Name:GONZALEZ, JOANNE (PHD)
Entity Type:Individual
Prefix:
First Name:JOANNE
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 1:2250 CHAPEL AVE W STE 100
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2051
Mailing Address - Country:US
Mailing Address - Phone:856-482-9000
Mailing Address - Fax:856-482-1159
Practice Address - Street 1:2250 CHAPEL AVE W STE 100
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002
Practice Address - Country:US
Practice Address - Phone:856-482-9000
Practice Address - Fax:856-482-1159
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00408500103TC0700X, 103TS0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ462971OtherMEDICARE
NJ0491772Medicaid