Provider Demographics
NPI:1215655030
Name:CLAUDIO GONZALEZ, WILBERT (MSW)
Entity type:Individual
Prefix:
First Name:WILBERT
Middle Name:
Last Name:CLAUDIO GONZALEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 15 BOX 15867
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9448
Mailing Address - Country:US
Mailing Address - Phone:787-324-4156
Mailing Address - Fax:
Practice Address - Street 1:URB. VILLA DE BUENA VENTURA
Practice Address - Street 2:CALLE GUARACA C13
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-324-4156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR255681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25568OtherCLINIC SOCIAL WORKER