Healthcare Provider Details

I. General information

NPI: 1699534461
Provider Name (Legal Business Name): WENDY S GONZALEZ-GALVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CIRCLE AVE
LYNN MA
01905-3050
US

IV. Provider business mailing address

111 TREMONT ST APT 201
BRIGHTON MA
02135-2434
US

V. Phone/Fax

Practice location:
  • Phone: 781-595-2413
  • Fax:
Mailing address:
  • Phone: 857-770-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number364SP0810X
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: