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General NPI Number Information
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NPI Number | 1033352778
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Entity Type | Organization
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Legal Business Name | EASTWEST PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 04/10/2009
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Last Update Date | 04/10/2009
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Provider Practice Location Address
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Address Line | 115 E 82ND ST SUITE 1A
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City | NEW YORK
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State | NY
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Zip | 10028-0831
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Country | US
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Telephone | 212-579-7666
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Fax |
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Provider Business Mailing Address
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Address Line | 115 E 82ND ST SUITE 1A
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City | NEW YORK
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State | NY
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Zip | 10028-0831
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Country | US
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Telephone | 212-579-7666
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. MARIA LOURDES GONZALES
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Credential | PSY.D.
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Telephone | 212-579-7666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | 015211-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 015211-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 015211-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | 015211-1
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 015211-1
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | 015211-1
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License Number State | NY
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Taxonomy #7
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 015211-1
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License Number State | NY
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