Provider Demographics
NPI:1285257204
Name:GONZALEZ, HEIDI
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
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 1:8 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3809
Mailing Address - Country:US
Mailing Address - Phone:857-523-9473
Mailing Address - Fax:
Practice Address - Street 1:70 EVERETT AVE STE 515
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2363
Practice Address - Country:US
Practice Address - Phone:774-512-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health