Provider Demographics
NPI:1366215865
Name:GONZALEZ-CANCEL, LUIS A (LMSW)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:GONZALEZ-CANCEL
Suffix:
Gender:M
Credentials:LMSW
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 1123
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1123
Mailing Address - Country:US
Mailing Address - Phone:787-403-5019
Mailing Address - Fax:
Practice Address - Street 1:#90
Practice Address - Street 2:CALLE ANTONIO JIMENEZ LANDRAU
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-403-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR91941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical