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General NPI Number Information
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NPI Number | 1548825706
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Entity Type | Individual
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Provider Name | MELY Z GONZALEZ MADERA CLINICAL SOCIAL WORK
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Gender | Female
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Dates
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Enumeration Date | 05/03/2019
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 307 AVENIDA ORTEGON 107 CAPARRA GALLERY
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City | GUAYNABO
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State | PR
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Zip | 00965-2505
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Country | US
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Telephone | 787-204-7699
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Fax |
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Provider Business Mailing Address
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Address Line | URB VILLAS DE LA CENTRAL VICTORIA 17 CALLE ESCARPIA
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City | JUNCOS
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State | PR
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Zip | 00777-0000
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Country | US
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Telephone | 787-204-7699
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11858
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License Number State | PR
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