Provider Demographics
NPI:1548452006
Name:GONZALEZ, DIANELSIE GUZMAN (PSYD)
Entity type:Individual
Prefix:
First Name:DIANELSIE
Middle Name:GUZMAN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FLORAL PARK
Mailing Address - Street 2:432 LLORENS TORES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3955
Mailing Address - Country:US
Mailing Address - Phone:939-630-4640
Mailing Address - Fax:
Practice Address - Street 1:429 CALLE LOS PINOS APT 1102
Practice Address - Street 2:CONDOMINIO FLORAL PLAZA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3409
Practice Address - Country:US
Practice Address - Phone:939-630-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1954103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical