Healthcare Provider Details

I. General information

NPI: 1750781639
Provider Name (Legal Business Name): HECTOR GONZALEZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 BROADWAY FL 2
NEW YORK NY
10012-3363
US

IV. Provider business mailing address

128 CYPRESS DR
COLONIA NJ
07067-1507
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-9537
  • Fax:
Mailing address:
  • Phone: 646-270-4826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number89457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: