Provider Demographics
NPI:1306077730
Name:GONZALEZ, GLORIA M (PHD, MS, LMHC)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHD, MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 NW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5725
Mailing Address - Country:US
Mailing Address - Phone:954-798-3629
Mailing Address - Fax:
Practice Address - Street 1:6701 NW 58TH ST
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5725
Practice Address - Country:US
Practice Address - Phone:954-798-3629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8376103K00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004173900Medicaid