Provider Demographics
NPI:1598089229
Name:LAUZURIQUE GONZALEZ, CARMEN R (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:R
Last Name:LAUZURIQUE 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 1:1848 SE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2875
Mailing Address - Country:US
Mailing Address - Phone:954-885-9500
Mailing Address - Fax:954-885-9444
Practice Address - Street 1:1848 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2875
Practice Address - Country:US
Practice Address - Phone:787-528-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1751103T00000X
FLPY10773103T00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist