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General NPI Number Information
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NPI Number | 1265043459
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Entity Type | Individual
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Provider Name | SELENE GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 274 MADISON AVE RM 1501
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City | NEW YORK
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State | NY
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Zip | 10016-0701
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Country | US
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Telephone | 917-544-3157
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Fax |
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Provider Business Mailing Address
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Address Line | 73 OAK RIDGE ST # 1
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City | GREENWICH
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State | CT
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Zip | 06830-5249
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Country | US
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Telephone | 917-544-3157
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 108106
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License Number State | NY
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