MEDICARE: NADIA GONZALES 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	090197-1	NY

General Provider Information

NPI Number	:	1700216652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADIA GONZALES LMSW

Provider Business Mailing Address
First Line	:	247-259 W 135TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030
Country	:	US
Telephone Number	:	646-259-2013
Fax Number	:

Provider Business Practice Location Address
First Line	:	247 W 135TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-2801
Country	:	US
Telephone Number	:	646-259-2013
Fax Number	:

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

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	11/13/2013

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