Provider Demographics
NPI:1558580167
Name:GONZALEZ, ROBERT II (LADC2)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:GONZALEZ
Suffix:II
Gender:M
Credentials:LADC2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CONGRESS AVE APT 34
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-3553
Mailing Address - Country:US
Mailing Address - Phone:617-688-4799
Mailing Address - Fax:
Practice Address - Street 1:250 CONGRESS AVE APT 34
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-3553
Practice Address - Country:US
Practice Address - Phone:617-688-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)