Provider Demographics
NPI:1588939888
Name:GONZALEZ, GLADYS YOMARIS (MSW)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:YOMARIS
Last Name:GONZALEZ
Suffix:
Gender:F
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:URB. LEVITTOWN
Mailing Address - Street 2:CALLE MONSITA FERRER HG 32
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-702-5880
Mailing Address - Fax:
Practice Address - Street 1:CONDOMINIO LAGOS DEL NORTE
Practice Address - Street 2:APARTAMENTO 806
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-0000
Practice Address - Country:US
Practice Address - Phone:787-702-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR107431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical