Healthcare Provider Details

I. General information

NPI: 1033352778
Provider Name (Legal Business Name): EASTWEST PSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 82ND ST SUITE 1A
NEW YORK NY
10028-0831
US

IV. Provider business mailing address

115 E 82ND ST SUITE 1A
NEW YORK NY
10028-0831
US

V. Phone/Fax

Practice location:
  • Phone: 212-579-7666
  • Fax:
Mailing address:
  • Phone: 212-579-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number015211-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number015211-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number015211-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number015211-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number015211-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number015211-1
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number015211-1
License Number StateNY

VIII. Authorized Official

Name: DR. MARIA LOURDES GONZALES
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 212-579-7666