Provider Demographics
NPI:1952655680
Name:GASPAR GONZALEZ, ANDREA CHRISTINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:CHRISTINE
Last Name:GASPAR GONZALEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 N PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4105
Mailing Address - Country:US
Mailing Address - Phone:224-544-9219
Mailing Address - Fax:
Practice Address - Street 1:225 E DEERPATH STE 280
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1973
Practice Address - Country:US
Practice Address - Phone:224-544-9219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010302103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical