MEDICARE: DR. MANUEL ANTHONY CARL GONZALEZ PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist	0810006462	VA
3	103TC0700X	Clinical Psychologist	PY 60414394	WA

General Provider Information

NPI Number	:	1164623005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL ANTHONY CARL GONZALEZ PSYD

Provider Business Mailing Address
First Line	:	2817 ROCK MERRITT AVENUE WOMACK ARMY MEDICAL CENTER
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:	910-907-8922
Fax Number	:	910-907-6069

Provider Business Practice Location Address
First Line	:	2817 ROCK MERRITT AVENUE
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-2229
Country	:	US
Telephone Number	:	910-907-8922
Fax Number	:	910-907-6069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	03/25/2025

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