Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 052454 | CT |
NPI | 1588959068 |
---|---|
Provider Name | Dr. Alberto Luis Gonzalez |
First Address | Hartford, CT 06112-1274 |
Second Address | Hartford, CT 06112-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2011 |
Last Update Date | 10/09/2018 |