Provider Demographics
NPI:1497786909
Name:GONZALEZ, DIMARY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIMARY
Middle Name:
Last Name:GONZALEZ
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:E43 CALLE MARIANA BRACETTI
Mailing Address - Street 2:URB. BORINQUEN
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-3348
Mailing Address - Country:US
Mailing Address - Phone:787-642-3237
Mailing Address - Fax:
Practice Address - Street 1:40 CALLE BRAU
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-221-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2397103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical