Provider Demographics
NPI:1457659484
Name:GONZALEZ, ELSIE M (PSYD, MSW)
Entity Type:Individual
Prefix:DR
First Name:ELSIE
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PSYD, MSW
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:URB PALACIOS REALES 137 CALLE ZARZUELA
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-4912
Mailing Address - Country:US
Mailing Address - Phone:787-310-8689
Mailing Address - Fax:
Practice Address - Street 1:SANTA CRUZ STREET 73
Practice Address - Street 2:EDIFICIO SANTA CRUZ STE 314
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-787-0171
Practice Address - Fax:787-395-7451
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR3882103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist