Provider Demographics
NPI:1013472257
Name:SERRANO GONZALEZ, DANIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:SERRANO GONZALEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CALLE BALBOA
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-6823
Mailing Address - Country:US
Mailing Address - Phone:787-908-2412
Mailing Address - Fax:
Practice Address - Street 1:2301 CARR 2 STE 215
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-3240
Practice Address - Country:US
Practice Address - Phone:787-908-2412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
PR6913103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist