Provider Demographics
NPI:1669170601
Name:GONZALEZ, MIDALYS (PSYCHOLOGIST, MS)
Entity type:Individual
Prefix:MRS
First Name:MIDALYS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PSYCHOLOGIST, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 5290
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9603
Mailing Address - Country:US
Mailing Address - Phone:939-247-1887
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY NO. 2 KM 157.9 SABALOS NUEVO NEIGHBORHOOD
Practice Address - Street 2:410 AVE. HOSTOS, SUITE 7 AP.#11
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682
Practice Address - Country:US
Practice Address - Phone:787-833-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7003103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling