Provider Demographics
NPI:1518515519
Name:GONZALEZ, NYDIA IRIS (LCPC)
Entity type:Individual
Prefix:
First Name:NYDIA
Middle Name:IRIS
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7936 W GRAND AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-2346
Mailing Address - Country:US
Mailing Address - Phone:773-593-1822
Mailing Address - Fax:
Practice Address - Street 1:1116 N KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-4152
Practice Address - Country:US
Practice Address - Phone:773-772-8009
Practice Address - Fax:773-292-5490
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health