Idalisse Marie Gonzalez, MS

Primary specialty

Health Service PsychologistTaxonomy code 103TH0100X

License

7545 Issued in PR

Practice address

4972 Ave Militar
Isabela, PR 00662-4163

Phone

(787) 365-0465

NPI assigned

Oct 20, 2025

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1760918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760918400000",
    "number": "1053288456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4972 AVE MILITAR",
            "city": "ISABELA",
            "state": "PR",
            "postal_code": "006624163",
            "telephone_number": "787-365-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4972 AVE MILITAR",
            "city": "ISABELA",
            "state": "PR",
            "postal_code": "006624163",
            "telephone_number": "787-365-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "IDALISSE",
        "middle_name": "MARIE",
        "credential": "MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-10-20",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "PR",
            "license": "7545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gail Vanesa Gonzalez Corchado, M.D.
• Justo Luis Gonzalez Fabian
• Javier Gonzalez Ortiz, R. PH.
• Astrid N Gonzalez, MS, SLP
• Daisy Quiles Gonzalez, M.A.C.P.L.
• Luz M Gonzalez
• Maria De Lourdes Gonzalez, M.D.
• Nilsa Ivette Gonzalez, RT
• Olga Maria Gonzalez, L.N.D.
• Wanda T Gonzalez, LICENSE

• Health Service Psychologist in Isabela, PR
• Providers in Isabela, PR by specialty
• Health Service Psychologist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.