Provider Demographics
NPI:1740431030
Name:GONZALEZ, RAFAEL ALBERTO (PHD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ALBERTO
Last Name: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 1:512 CALLE WILLIAM JONES
Mailing Address - Street 2:
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00915-3435
Mailing Address - Country:US
Mailing Address - Phone:787-460-4733
Mailing Address - Fax:
Practice Address - Street 1:207 AVE DOMENECH
Practice Address - Street 2:OFFICE 108
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3523
Practice Address - Country:US
Practice Address - Phone:787-758-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-04
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2984103TA0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging