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General NPI Number Information
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NPI Number | 1104462647
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Entity Type | Individual
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Provider Name | JOSE RAPHAEL GONZALEZ PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 1848 SE 1ST AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2875
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Country | US
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Telephone | 954-885-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 SW 108TH AVE
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City | MIAMI
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State | FL
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Zip | 33165-3510
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Country | US
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Telephone | 305-218-2425
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH13471
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License Number State | FL
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