Provider Demographics
NPI:1811590359
Name:GONZALEZ, IRIS SHAKIRA (MSW)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:SHAKIRA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CALLE MANUEL CRUZ
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-3627
Mailing Address - Country:US
Mailing Address - Phone:787-380-8162
Mailing Address - Fax:
Practice Address - Street 1:56 CALLE MANUEL CRUZ
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3627
Practice Address - Country:US
Practice Address - Phone:787-380-8162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR153041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty