Provider Demographics
NPI:1871023838
Name:GONZALEZ, DOLLY ANGELLIE (MA)
Entity Type:Individual
Prefix:
First Name:DOLLY
Middle Name:ANGELLIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3875
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3875
Mailing Address - Country:US
Mailing Address - Phone:787-313-2449
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 133.5
Practice Address - Street 2:EDIFICIO CENTERPLEC SUITE 307
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-313-2249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5809103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty