Provider Demographics
NPI:1639331044
Name:GONZALEZ, ROSA (LMHC)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15476 NW 77TH CT
Mailing Address - Street 2:SUITE 118
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5823
Mailing Address - Country:US
Mailing Address - Phone:786-553-3596
Mailing Address - Fax:954-239-8041
Practice Address - Street 1:16969 NW 67TH AVE
Practice Address - Street 2:SUITE.202
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4214
Practice Address - Country:US
Practice Address - Phone:786-553-3596
Practice Address - Fax:954-239-8041
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health