Healthcare Provider Details

I. General information

NPI: 1003290958
Provider Name (Legal Business Name): KARINA MELISSA GONZALEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 ADAM CLAYTON POWELL JR BLVD
NEW YORK NY
10027-4990
US

IV. Provider business mailing address

181 E 206TH ST APT 2A
BRONX NY
10458-1151
US

V. Phone/Fax

Practice location:
  • Phone: 212-553-6708
  • Fax:
Mailing address:
  • Phone: 347-542-0053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number085075-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: