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General NPI Number Information
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NPI Number | 1669926135
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Entity Type | Organization
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Legal Business Name | LORRAINE GONZALEZ LCSW PLLC
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Dates
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Enumeration Date | 08/12/2016
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 2174 HEWLETT AVE SUITE 211
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City | MERRICK
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State | NY
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Zip | 11566-3606
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Country | US
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Telephone | 917-396-2290
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Fax |
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Provider Business Mailing Address
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Address Line | 921 LEE RD
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City | WANTAGH
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State | NY
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Zip | 11793-1025
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Country | US
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Telephone | 917-396-2290
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LORRAINE GONZALEZ
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Credential | LCSW
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Telephone | 917-396-2290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R076167
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License Number State | NY
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