Provider Demographics
NPI:1699016345
Name:GONZALEZ WONGVALLE, ISABEL (PSYD, LMHC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ISABEL
Middle Name:
Last Name:GONZALEZ WONGVALLE
Suffix:
Gender:F
Credentials:PSYD, LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NE 191ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3969
Mailing Address - Country:US
Mailing Address - Phone:786-426-9176
Mailing Address - Fax:
Practice Address - Street 1:10691 N KENDALL DR STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1596
Practice Address - Country:US
Practice Address - Phone:305-668-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11662101YM0800X
FLMT2763106H00000X
FLPY10951103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist