Provider Demographics
NPI:1619641651
Name:GONZALEZ, NATALIA (BA)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 RUSTIC DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9209
Mailing Address - Country:US
Mailing Address - Phone:787-613-3180
Mailing Address - Fax:
Practice Address - Street 1:121 WEBB DR STE 400
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3904
Practice Address - Country:US
Practice Address - Phone:863-483-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health