Healthcare Provider Details

I. General information

NPI: 1588945414
Provider Name (Legal Business Name): WILMA C GONZALEZ M.S.W., P.H.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRET 693 , KM 14.2 BO BRENAS
VEGA ALTA PR
00692
US

IV. Provider business mailing address

PO BOX 468
VEGA BAJA PR
00694-0468
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-2686
  • Fax: 787-270-5292
Mailing address:
  • Phone: 787-270-2686
  • Fax: 787-270-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9812
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: