Healthcare Provider Details

I. General information

NPI: 1427893825
Provider Name (Legal Business Name): JOHNDAVID GONZALEZ LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRIDGE ST STE 22
IRVINGTON NY
10533-1551
US

IV. Provider business mailing address

2394 MARK RD
YORKTOWN HEIGHTS NY
10598-3527
US

V. Phone/Fax

Practice location:
  • Phone: 929-352-6384
  • Fax: 888-972-5017
Mailing address:
  • Phone: 845-849-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. ILENE KASWER
Title or Position: OFFICE MANAGER
Credential:
Phone: 845-849-1958