MEDICARE: DR. MARIA LOURDES GONZALEZ PH.D.

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	103TC0700X	Clinical Psychologist	2747	NJ

General Provider Information

NPI Number	:	1801929880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA LOURDES GONZALEZ PH.D.

Provider Business Mailing Address
First Line	:	80 RIVER ST
Second Line	:	SUITE 303
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-5626
Country	:	US
Telephone Number	:	201-420-6770
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 RIVER ST
Second Line	:	SUITE 303
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-5626
Country	:	US
Telephone Number	:	201-420-6770
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	11/29/2011

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