Healthcare Provider Details

I. General information

NPI: 1912555921
Provider Name (Legal Business Name): GABRIELA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 AMORY ST
ROXBURY MA
02119-1012
US

IV. Provider business mailing address

20 VINING ST
BOSTON MA
02115-6115
US

V. Phone/Fax

Practice location:
  • Phone: 617-652-9031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10001295
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: