Provider Demographics
NPI:1750823258
Name:PSYCHOLOGIST ADRIANA L GONZALEZ PHD PLLC
Entity type:Organization
Organization Name:PSYCHOLOGIST ADRIANA L GONZALEZ PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-514-0657
Mailing Address - Street 1:315 SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-5128
Mailing Address - Country:US
Mailing Address - Phone:203-514-0657
Mailing Address - Fax:845-818-3500
Practice Address - Street 1:315 SECOND AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-5128
Practice Address - Country:US
Practice Address - Phone:203-514-0657
Practice Address - Fax:845-818-3500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCHOLOGIST ADRIANA L GONZALEZ PHD PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-15
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03535733Medicaid