Provider Demographics
NPI:1558517847
Name:GONZALEZ-EASTEP, DIANA PATRICIA (PHD)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:PATRICIA
Last Name:GONZALEZ-EASTEP
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 1:11602 NW 69TH TER
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-5541
Mailing Address - Country:US
Mailing Address - Phone:617-869-1933
Mailing Address - Fax:
Practice Address - Street 1:11602 NW 69TH TER
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-5541
Practice Address - Country:US
Practice Address - Phone:617-869-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9269103TC1900X
FLPY 8351103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling