Healthcare Provider Details

I. General information

NPI: 1912818923
Provider Name (Legal Business Name): GISSELA ALEJANDRA GONZALEZ LMSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6415 COOPER AVE APT 2R
GLENDALE NY
11385-6181
US

IV. Provider business mailing address

6415 COOPER AVE APT 2R
GLENDALE NY
11385-6181
US

V. Phone/Fax

Practice location:
  • Phone: 917-615-2693
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number132623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: