Provider Demographics
NPI:1437353240
Name:GONZALEZ, MABEL (MAED)
Entity Type:Individual
Prefix:MISS
First Name:MABEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EE32 CALLE 30
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-2607
Mailing Address - Country:US
Mailing Address - Phone:787-638-9914
Mailing Address - Fax:
Practice Address - Street 1:EE32 CALLE 30
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-2607
Practice Address - Country:US
Practice Address - Phone:787-638-9914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1752101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional