Healthcare Provider Details

I. General information

NPI: 1669170601
Provider Name (Legal Business Name): MIDALYS GONZALEZ PSYCHOLOGIST, MS.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY NO. 2 KM 157.9 SABALOS NUEVO NEIGHBORHOOD 410 AVE. HOSTOS, SUITE 7 AP.#11
MAYAGUEZ PR
00682
US

IV. Provider business mailing address

HC 1 BOX 5290
MOCA PR
00676-9603
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax:
Mailing address:
  • Phone: 939-247-1887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7003
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: