Provider Demographics
NPI:1518696541
Name:IRIZARRY GONZALEZ, LOURDES N (MPHE)
Entity Type:Individual
Prefix:MISS
First Name:LOURDES
Middle Name:N
Last Name:IRIZARRY GONZALEZ
Suffix:
Gender:F
Credentials:MPHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LAKESHORE CTR UNIT 1155
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-1081
Mailing Address - Country:US
Mailing Address - Phone:787-383-6833
Mailing Address - Fax:
Practice Address - Street 1:5 LAKESHORE CTR UNIT 1155
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-1081
Practice Address - Country:US
Practice Address - Phone:787-383-6833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor