Healthcare Provider Details

I. General information

NPI: 1508671561
Provider Name (Legal Business Name): BRIANNA MARIE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WHITESVILLE RD
TOMS RIVER NJ
08753-4105
US

IV. Provider business mailing address

6 ROGER AVE
LINCROFT NJ
07738-1716
US

V. Phone/Fax

Practice location:
  • Phone: 732-797-2505
  • Fax:
Mailing address:
  • Phone: 732-272-2738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: