Provider Demographics
NPI:1730117243
Name:GONZALEZ, LORNA O (PSYD)
Entity Type:Individual
Prefix:
First Name:LORNA
Middle Name:O
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COLINAS DEL BOSQUE 1150
Mailing Address - Street 2:CARR # 2 APTDO 30
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-612-1997
Mailing Address - Fax:
Practice Address - Street 1:QUADRANGLE MEDICAL CENTER
Practice Address - Street 2:AVE. MUNOZ MARIN # 50
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:74981
Practice Address - Country:US
Practice Address - Phone:787-744-0857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2253103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist