Provider Demographics
NPI:1750785457
Name:GONZALEZ REVERON, CINTHYA M
Entity type:Individual
Prefix:MRS
First Name:CINTHYA
Middle Name:M
Last Name:GONZALEZ REVERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 N STERLING RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2033
Mailing Address - Country:US
Mailing Address - Phone:787-585-3619
Mailing Address - Fax:
Practice Address - Street 1:2215 N AMERICAN STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133
Practice Address - Country:US
Practice Address - Phone:215-425-6203
Practice Address - Fax:215-425-6204
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2074235Z00000X
PASL012792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist