Healthcare Provider Details

I. General information

NPI: 1558248252
Provider Name (Legal Business Name): MS. EMINESSE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 RICHBELL RD APT C2
MAMARONECK NY
10543-3208
US

IV. Provider business mailing address

106 RICHBELL RD APT C2
MAMARONECK NY
10543-3208
US

V. Phone/Fax

Practice location:
  • Phone: 646-463-4646
  • Fax:
Mailing address:
  • Phone: 646-463-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: