Provider Demographics
NPI:1265755318
Name:GONZALEZ DIAZ, MICHELLE MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:GONZALEZ DIAZ
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Gender:F
Credentials:PSYD
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Mailing Address - Street 1:4N8 CALLE 206
Mailing Address - Street 2:COLINAS FAIR VIEW
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-8239
Mailing Address - Country:US
Mailing Address - Phone:787-587-3656
Mailing Address - Fax:787-755-2283
Practice Address - Street 1:458 CALLE JOSE CANALS
Practice Address - Street 2:URB ROOSEVELT
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-587-3656
Practice Address - Fax:787-753-8696
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
PR3552103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical