MEDICARE: ASIA GONZALEZ LPC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1861866394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASIA GONZALEZ LPC

Provider Business Mailing Address
First Line	:	30 FOREST AVE
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-3933
Country	:	US
Telephone Number	:	203-530-3378
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 EVERGREEN AVE
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06518-2717
Country	:	US
Telephone Number	:	203-530-3378
Fax Number	:

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

Provider Enumeration Date	:	11/20/2015
Last Update Date	:	11/14/2022

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Directions to “ ASIA GONZALEZ LPC” Practice Location

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