Provider Demographics
NPI:1063381911
Name:GONZALEZ, ELISE Y
Entity type:Individual
Prefix:MISS
First Name:ELISE
Middle Name:Y
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71325
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8425
Mailing Address - Country:US
Mailing Address - Phone:787-384-5929
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 71325
Practice Address - Street 2:STE 8
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-8425
Practice Address - Country:US
Practice Address - Phone:787-384-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8410103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist