Provider Demographics
NPI:1174149843
Name:GONZALEZ, CORALIS NAOMI (MSW)
Entity type:Individual
Prefix:MRS
First Name:CORALIS
Middle Name:NAOMI
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSW
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 1403
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1403
Mailing Address - Country:US
Mailing Address - Phone:787-224-7144
Mailing Address - Fax:
Practice Address - Street 1:28 CALLE MUNOZ RIVERA W
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677-2127
Practice Address - Country:US
Practice Address - Phone:787-823-5500
Practice Address - Fax:787-823-2990
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR149861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14986Medicaid