Provider Demographics
NPI:1487432241
Name:GONZALES, MARYKATE (PSYD)
Entity type:Individual
Prefix:
First Name:MARYKATE
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BOW RD E
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-2834
Mailing Address - Country:US
Mailing Address - Phone:609-851-2678
Mailing Address - Fax:
Practice Address - Street 1:800 SLOAN AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-2105
Practice Address - Country:US
Practice Address - Phone:609-851-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100398500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist