Healthcare Provider Details

I. General information

NPI: 1265620074
Provider Name (Legal Business Name): SAKIMA GONZALEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 TILDEN ST ASTOR CHILD GUIDANCE CENTER
BRONX NY
10467
US

IV. Provider business mailing address

610 ANDERSON AVE APT 1F
CLIFFSIDE PARK NJ
07010-1845
US

V. Phone/Fax

Practice location:
  • Phone: 718-231-3400
  • Fax: 718-655-3503
Mailing address:
  • Phone: 347-605-3518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number074748-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44CS05429200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: