Healthcare Provider Details

I. General information

NPI: 1750823258
Provider Name (Legal Business Name): PSYCHOLOGIST ADRIANA L GONZALEZ PHD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 SECOND AVE
WEST HAVEN CT
06516-5128
US

IV. Provider business mailing address

315 SECOND AVE
WEST HAVEN CT
06516-5128
US

V. Phone/Fax

Practice location:
  • Phone: 203-514-0657
  • Fax: 845-818-3500
Mailing address:
  • Phone: 203-514-0657
  • Fax: 845-818-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA LAURA GONZALEZ
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 203-514-0657