Provider Demographics
NPI:1700014966
Name:GONZALEZ, REBECCA (BS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1812
Mailing Address - Country:US
Mailing Address - Phone:617-354-2275
Mailing Address - Fax:
Practice Address - Street 1:5 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1812
Practice Address - Country:US
Practice Address - Phone:617-354-2275
Practice Address - Fax:617-547-4356
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator