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General NPI Number Information
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NPI Number | 1275379562
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Entity Type | Individual
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Provider Name | KATHY GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 07/05/2024
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Last Update Date | 09/02/2024
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Provider Practice Location Address
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Address Line | 256 WASHINGTON ST
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City | MOUNT VERNON
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State | NY
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Zip | 10553-1052
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Country | US
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Telephone | 914-613-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 22 SHERWOOD AVE # 2
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City | YONKERS
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State | NY
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Zip | 10704-2506
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Country | US
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Telephone | 914-226-1943
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | NYPCPS-P-5624
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License Number State | NY
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