MEDICARE: GLADYS YOMARIS GONZALEZ MSW

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
1	1041C0700X	Clinical Social Worker	10743	PR

General Provider Information

NPI Number	:	1588939888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLADYS YOMARIS GONZALEZ MSW

Provider Business Mailing Address
First Line	:	URB. LEVITTOWN
Second Line	:	CALLE MONSITA FERRER HG 32
City	:	TOA BAJA
State	:	PR
Zip	:	00949
Country	:	US
Telephone Number	:	787-702-5880
Fax Number	:

Provider Business Practice Location Address
First Line	:	CONDOMINIO LAGOS DEL NORTE
Second Line	:	APARTAMENTO 806
City	:	TOA BAJA
State	:	PR
Zip	:	00949-0000
Country	:	US
Telephone Number	:	787-702-5880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	03/20/2012

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