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General NPI Number Information
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NPI Number | 1316512460
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Entity Type | Individual
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Provider Name | CORALYS NICOLE SANTIAGO GONZALEZ PSYD
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Gender | Female
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 80 STATE ST
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City | SPRINGFIELD
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State | MA
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Zip | 01103-2010
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Country | US
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Telephone | 413-218-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 70 RITTENHOUSE TER
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City | SPRINGFIELD
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State | MA
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Zip | 01108-2234
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Country | US
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Telephone | 787-404-7187
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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