Provider Demographics
NPI:1104992239
Name:GONZALEZ, MAX A (PHD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8953 SW 96TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2929
Mailing Address - Country:US
Mailing Address - Phone:305-642-5255
Mailing Address - Fax:305-642-8850
Practice Address - Street 1:1250 SW 27TH AVE
Practice Address - Street 2:STE 404
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135
Practice Address - Country:US
Practice Address - Phone:305-642-5255
Practice Address - Fax:305-642-8850
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6082103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007219800Medicaid