Provider Demographics
NPI:1700848199
Name:GONZALEZ, MANUELA I (PSY D)
Entity Type:Individual
Prefix:DR
First Name:MANUELA
Middle Name:I
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 3 C-12
Mailing Address - Street 2:MANSIONES DE GUAYNABO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-287-5359
Mailing Address - Fax:787-287-5359
Practice Address - Street 1:CALLE SANTA MARIA M3 LOCAL #1
Practice Address - Street 2:URBANIZACION BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-948-7610
Practice Address - Fax:787-716-0946
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2250103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical