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General NPI Number Information
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NPI Number | 1740854959
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Entity Type | Individual
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Provider Name | ANA P GONZALEZ MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 05/13/2021
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 18 MICROLAB RD STE 3
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City | LIVINGSTON
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State | NJ
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Zip | 07039-1640
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Country | US
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Telephone | 862-253-3109
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Fax |
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Provider Business Mailing Address
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Address Line | 34 WESSINGTON AVE
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City | GARFIELD
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State | NJ
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Zip | 07026-3206
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Country | US
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Telephone | 973-563-8378
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-72745
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License Number State | NJ
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