Provider Demographics
NPI:1801929880
Name:GONZALEZ, MARIA LOURDES (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LOURDES
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 RIVER ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5626
Mailing Address - Country:US
Mailing Address - Phone:201-420-6770
Mailing Address - Fax:
Practice Address - Street 1:80 RIVER ST
Practice Address - Street 2:SUITE 303
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5626
Practice Address - Country:US
Practice Address - Phone:201-420-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2747103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJGO661098Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST