Healthcare Provider Details

I. General information

NPI: 1922370592
Provider Name (Legal Business Name): LILYBETH GONZALEZ PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO AZUCENAS 2501 SEGUNDA SECCION LEVITTOWN
TOA BAJA PUERTO RICO
00949
UM

IV. Provider business mailing address

2501 PASEO AZUCENA SEGUNDA SECCION DE LEVITTOWN
TOA BAJA PR
00949-4345
US

V. Phone/Fax

Practice location:
  • Phone: 787-269-5150
  • Fax: 787-269-5150
Mailing address:
  • Phone: 787-269-5150
  • Fax: 787-269-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5463
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number5463
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number5463
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: