Provider Demographics
NPI:1437582855
Name:GONZALEZ, IVONNE D
Entity Type:Individual
Prefix:MS
First Name:IVONNE
Middle Name:D
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14401 JOSE VEDRA BLVD
Mailing Address - Street 2:#2801
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2009
Mailing Address - Country:US
Mailing Address - Phone:912-275-1157
Mailing Address - Fax:
Practice Address - Street 1:14401 JOSE VEDRA BLVD
Practice Address - Street 2:#2801
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-2009
Practice Address - Country:US
Practice Address - Phone:912-275-1157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health