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General NPI Number Information
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NPI Number | 1477236768
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Entity Type | Individual
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Provider Name | AMANDA GABRIELLE GONZALEZ BA, MS.
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Gender | Female
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 2005 PALMER AVE # 606
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City | LARCHMONT
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State | NY
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Zip | 10538-2437
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Country | US
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Telephone | 855-400-5683
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Fax |
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Provider Business Mailing Address
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Address Line | 2 DARIAN CT APT 1A
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City | POMONA
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State | NY
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Zip | 10970-3015
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Country | US
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Telephone | 914-523-2416
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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