Provider Demographics
NPI:1538492152
Name:GONZALEZ-MARTINEZ, ISMAEL (PH D)
Entity type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:
Last Name:GONZALEZ-MARTINEZ
Suffix:
Gender:M
Credentials:PH D
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 8362
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0362
Mailing Address - Country:US
Mailing Address - Phone:787-753-5353
Mailing Address - Fax:
Practice Address - Street 1:605 AVE CONDADO
Practice Address - Street 2:SUITE 603
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3843
Practice Address - Country:US
Practice Address - Phone:787-753-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001736101Y00000X, 101YM0800X, 101YP2500X
PR003109103T00000X, 103TC1900X, 103TF0000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy