Provider Demographics
NPI:1548753338
Name:GONZALEZ, CAROL STEPHANIE (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:STEPHANIE
Last Name:GONZALEZ
Suffix:
Gender:F
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:APARTADO 265, URB. CIUDAD JARDIN
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-203-3739
Mailing Address - Fax:
Practice Address - Street 1:ISLA VERDE MALL, AVENIDA LOS GOBERNADORES
Practice Address - Street 2:SUITE 218
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-203-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling