Provider Demographics
NPI:1588945414
Name:GONZALEZ, WILMA C (MSW, PHD)
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:C
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-0468
Mailing Address - Country:US
Mailing Address - Phone:787-270-2686
Mailing Address - Fax:787-270-5292
Practice Address - Street 1:CARRET 693 , KM 14.2
Practice Address - Street 2:BO BRENAS
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-2686
Practice Address - Fax:787-270-5292
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
PR98121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical