MEDICARE: JULIA GONZALEZ MSW LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R035994-1	NY

General Provider Information

NPI Number	:	1003835380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA GONZALEZ MSW LCSW

Provider Business Mailing Address
First Line	:	922 HARMON DR
Second Line	:
City	:	LARCHMONT
State	:	NY
Zip	:	10538-1800
Country	:	US
Telephone Number	:	914-834-2128
Fax Number	:	914-834-2128

Provider Business Practice Location Address
First Line	:	2436 EASTCHESTER RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5916
Country	:	US
Telephone Number	:	914-834-2128
Fax Number	:	914-834-2128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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