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NPI Code Detail

MEDICARE: YASMINA R GONZALEZ

MEDICARE:   YASMINA R GONZALEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1124383815
Entity Type Code : Individual
Provider Name (Legal Business Name) : YASMINA R GONZALEZ
Provider Business Mailing Address
First Line : 67 CAMBRIDGE ST
Second Line : APARTMENT #1
City : WORCESTER
State : MA
Zip : 01603-2344
Country : US
Telephone Number : 508-715-5825
Fax Number :
Provider Business Practice Location Address
First Line : 11 SYCAMORE ST
Second Line :
City : WORCESTER
State : MA
Zip : 01608-2213
Country : US
Telephone Number : 508-798-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2012
Last Update Date : 07/09/2012

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Directions to “ YASMINA R GONZALEZ ” Practice Location

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