Healthcare Provider Details

I. General information

NPI: 1770287765
Provider Name (Legal Business Name): NATALI GONZALEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E 1ST ST STE 202
CORNING NY
14830-2710
US

IV. Provider business mailing address

105 E 1ST ST STE 202
CORNING NY
14830-2710
US

V. Phone/Fax

Practice location:
  • Phone: 607-205-8848
  • Fax: 607-201-0300
Mailing address:
  • Phone: 607-205-8848
  • Fax: 607-201-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW025644
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104149
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: