Healthcare Provider Details

I. General information

NPI: 1689510323
Provider Name (Legal Business Name): VIDA PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 PEARL ST APT 3
CAMBRIDGE MA
02139-4571
US

IV. Provider business mailing address

PO BOX 391116
CAMBRIDGE MA
02139-0012
US

V. Phone/Fax

Practice location:
  • Phone: 978-578-9090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: GABRIELA MARIE GONZALEZ
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 978-578-9090