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General NPI Number Information
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NPI Number | 1760637730
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Entity Type | Individual
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Provider Name | LUIS A. GONZALEZ CASAC-T
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Gender | Male
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/25/2008
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Provider Practice Location Address
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Address Line | 100 NORTH BROADWAY
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City | YONKERS
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State | NY
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Zip | 10701
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Country | US
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Telephone | 914-376-7618
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Fax |
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Provider Business Mailing Address
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Address Line | 317 SOUTH BROADWAY 1ST FLOOR
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City | YONKERS
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State | NY
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Zip | 10705
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Country | US
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Telephone | 914-476-6502
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Fax | 914-476-2421
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20973
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License Number State | NY
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