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General NPI Number Information
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NPI Number | 1689510323
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Entity Type | Organization
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Legal Business Name | VIDA PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 262 PEARL ST APT 3
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City | CAMBRIDGE
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State | MA
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Zip | 02139-4571
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Country | US
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Telephone | 978-578-9090
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 391116
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City | CAMBRIDGE
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State | MA
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Zip | 02139-0012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | GABRIELA MARIE GONZALEZ
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Credential | PSYD
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Telephone | 978-578-9090
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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 |
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License Number State |
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