Provider Demographics
NPI:1194150672
Name:FONT, GINA (MA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:FONT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. PUERTO NUEVO 8NW ST.
Mailing Address - Street 2:1371
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-2246
Mailing Address - Country:US
Mailing Address - Phone:787-513-5774
Mailing Address - Fax:
Practice Address - Street 1:URB. PUERTO NUEVO 8NW ST.
Practice Address - Street 2:1371
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2246
Practice Address - Country:US
Practice Address - Phone:787-513-5774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4264103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling