Provider Demographics
NPI:1457029936
Name:GONZALEZ PICO, MARIA A (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:GONZALEZ PICO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B5 TABONUCO ST
Mailing Address - Street 2:SUITE 216 PMB 344
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-587-0388
Mailing Address - Fax:
Practice Address - Street 1:431 AVENIDA DE LA CONSTITUCION
Practice Address - Street 2:NATIONAL PLAZA 1601
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-903-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7006103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty