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General NPI Number Information
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NPI Number | 1518151109
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Entity Type | Individual
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Provider Name | GRETCHEN J GONZALEZ RIVERA MS,PSY.D
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Gender | Female
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 12/27/2016
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Provider Practice Location Address
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Address Line | 355 AVE HOSTOS URB. ROOSEVELT
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City | SAN JUAN
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State | PR
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Zip | 00918-2322
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Country | US
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Telephone | 787-767-4076
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Fax | 787-767-4076
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Provider Business Mailing Address
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Address Line | 10 FLAMINGO APARTMENTS APTO. 6201
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City | BAYAMON
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State | PR
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Zip | 00959-4322
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Country | US
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Telephone | 787-410-6425
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1901
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License Number State | PR
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