Provider Demographics
NPI:1487147302
Name:GONZALEZ, RAFAEL ALBERTO (LMHC (MH 16065))
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ALBERTO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LMHC (MH 16065)
Other - Prefix:
Other - First Name:RAFA
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:9100 CONROY WINDERMERE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-8431
Mailing Address - Country:US
Mailing Address - Phone:407-801-3442
Mailing Address - Fax:
Practice Address - Street 1:9100 CONROY WINDERMERE RD STE 200
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-8431
Practice Address - Country:US
Practice Address - Phone:407-801-3442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health