Healthcare Provider Details

I. General information

NPI: 1558630822
Provider Name (Legal Business Name): DORIS FOFIE-GONZALEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 2ND AVE FL 3
BROOKLYN NY
11215-2711
US

IV. Provider business mailing address

15 2ND AVE FL 3
BROOKLYN NY
11215-2711
US

V. Phone/Fax

Practice location:
  • Phone: 718-514-6007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number083622
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: