Provider Demographics
NPI:1104095819
Name:GONZALES, ELENA VERONICA (PHD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:VERONICA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:ELENA
Other - Middle Name:VERONICA
Other - Last Name:SUTINEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 70612
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94807-0612
Mailing Address - Country:US
Mailing Address - Phone:510-965-3920
Mailing Address - Fax:510-439-4150
Practice Address - Street 1:1160 BRICKYARD COVE RD
Practice Address - Street 2:SCHOONER BLDG. SUITE 200
Practice Address - City:POINT RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-4107
Practice Address - Country:US
Practice Address - Phone:510-965-3920
Practice Address - Fax:510-439-4150
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20826103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical