MEDICARE: CERESA GONZALEZ LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	102526	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235644691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CERESA GONZALEZ LMSW

Provider Business Mailing Address
First Line	:	750 TILDEN ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-6013
Country	:	US
Telephone Number	:	718-231-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 SCHIEFFELIN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-5605
Country	:	US
Telephone Number	:	718-231-3400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2017
Last Update Date	:	12/07/2017

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