Provider Demographics
NPI:1750823258
Name:PSYCHOLOGIST ADRIANA L GONZALEZ PHD PLLC
Entity Type:Organization
Organization Name:PSYCHOLOGIST ADRIANA L GONZALEZ PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-514-0657
Mailing Address - Street 1:85 HILLCREST TER
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6128
Mailing Address - Country:US
Mailing Address - Phone:203-514-0657
Mailing Address - Fax:845-818-3500
Practice Address - Street 1:85 HILLCREST TER
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6128
Practice Address - Country:US
Practice Address - Phone:203-514-0657
Practice Address - Fax:845-818-3500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCHOLOGIST ADRIANA L GONZALEZ PHD PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-15
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019350251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03535733Medicaid