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General NPI Number Information
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NPI Number | 1790802783
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Entity Type | Individual
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Provider Name | NINA ELENA FEDIRKO-GONZALEZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 626 WILLIS AVE
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City | WILLISTON PARK
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State | NY
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Zip | 11596-1149
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Country | US
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Telephone | 516-742-1182
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Fax | 516-742-1182
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Provider Business Mailing Address
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Address Line | 84 EVANS AVE
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City | ALBERTSON
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State | NY
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Zip | 11507-1827
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Country | US
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Telephone | 516-742-1182
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Fax | 516-742-1182
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R026152-1
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License Number State | NY
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