Provider Demographics
NPI:1821543083
Name:GONZALEZ, KAREN M
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CALLE E
Mailing Address - Street 2:APT. 208
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-2852
Mailing Address - Country:US
Mailing Address - Phone:787-668-6510
Mailing Address - Fax:
Practice Address - Street 1:227 CALLE E
Practice Address - Street 2:APT. 208
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-2852
Practice Address - Country:US
Practice Address - Phone:787-668-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3761103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist