Provider Demographics
NPI:1548825706
Name:GONZALEZ MADERA, MELY Z (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:DR
First Name:MELY
Middle Name:Z
Last Name:GONZALEZ MADERA
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:URB VILLAS DE LA CENTRAL VICTORIA
Mailing Address - Street 2:17 CALLE ESCARPIA
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-0000
Mailing Address - Country:US
Mailing Address - Phone:787-204-7699
Mailing Address - Fax:
Practice Address - Street 1:307 AVENIDA ORTEGON 107
Practice Address - Street 2:CAPARRA GALLERY
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00965-2505
Practice Address - Country:US
Practice Address - Phone:787-204-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR118581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR39793900Medicaid