Provider Demographics
NPI:1770858243
Name:LEBRON, YELITZA GONZALEZ (MPSY)
Entity Type:Individual
Prefix:
First Name:YELITZA
Middle Name:GONZALEZ
Last Name:LEBRON
Suffix:
Gender:F
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 CALLE ARENA HUMACAO
Mailing Address - Street 2:URB PALACIOS DEL SOL
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-218-9442
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 11702
Practice Address - Street 2:HC 02 BOX 11702
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-9348
Practice Address - Country:US
Practice Address - Phone:787-218-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5932103TC1900X
PR9365104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No104100000XBehavioral Health & Social Service ProvidersSocial Worker