Provider Demographics
NPI:1598849580
Name:GONZALEZ, JUANA R (LMHC LAPC)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:R
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMHC LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 CHESTNUT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2600
Mailing Address - Country:US
Mailing Address - Phone:857-244-9615
Mailing Address - Fax:
Practice Address - Street 1:583 CHESTNUT ST STE 1
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2600
Practice Address - Country:US
Practice Address - Phone:857-244-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5397101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor