MEDICARE: VIVIAN ESTHER GONZALEZ AMADOR LPC

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	MH25854	FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	004440	PR
3	101YP2500X	Professional Counselor	MH25854	FL
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	MH25854	FL
5	101YM0800X	Mental Health Counselor	00440	PR
6	101YP2500X	Professional Counselor	00440	PR

General Provider Information

NPI Number	:	1881221612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN ESTHER GONZALEZ AMADOR LPC

Provider Business Mailing Address
First Line	:	PO BOX 3844
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00681-3844
Country	:	US
Telephone Number	:	787-485-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 AVE HOSTOS STE 103
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00682-1540
Country	:	US
Telephone Number	:	787-485-0555
Fax Number	:

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

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	04/14/2026

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