Provider Demographics
NPI:1972168334
Name:GONZALEZ, ARLENE (SW)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:SW
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 3854
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3854
Mailing Address - Country:US
Mailing Address - Phone:787-546-7505
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 126.4
Practice Address - Street 2:BO CAIMITAL BAJO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-546-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7123Medicaid
PR7123OtherSOCIAL WORKER