Provider Demographics
NPI:1518999713
Name:GONZALEZ-PRENDES, A. ANTONIO (PHD)
Entity Type:Individual
Prefix:DR
First Name:A.
Middle Name:ANTONIO
Last Name:GONZALEZ-PRENDES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49940 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1579
Mailing Address - Country:US
Mailing Address - Phone:248-722-8679
Mailing Address - Fax:
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE #550
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-213-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010671411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ26429Medicare UPIN
MIQ26429040Medicare ID - Type Unspecified